9907-122 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full,force and effect.
License # Lic. Class Exp. Date
Date 1 .t _Signature. of Contractor` 1�
^.
OWNER -BUILDER DECLARATION '
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section -, B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(Y) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
CO.LIDE141 EA0a.13 'SWC 54 t 701 PU0
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of the work for which.this permit is issued,
I shall not employ any person in any manner so as to become subject to the
worker`s' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
ygode,I,shall forthwith comply with -those provisions.,.:o.,..�
ate: f "` °' is Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation:
I certify that I have read this application and state that the above information is
correct. I.agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
°Signature (Owner/Agerit)"� Date Z ' �1
BUILDING PERMIT PERMIT# y
`
,%62_ 20 LOT Sf TRACT 776 .
DATE t VALUATION $2,8
JOB SITE lSIC� ��Yf >L � i'RN A'ilJ.1 _-
ADDRESS \ ` g __ _
APN %b� 1
OWNER
CONTRACTOR/DESIGNER/ENGINEER
!"MMIE11IN H1.:1"S 111.11C
1:.C.1• 013 -WS ht SOUTH -9R'; HILLS, .LLC.
l �i3t3: i 11�1i�ivltli�I �� v E STi 1 tlti
55-060 PGA BL\M;
t, ILAN(A (-'A ';2 6
.LA. Q1;)!NTA. CA 922.5:3
('714)03.7260 Ct3.i:.tt W.7
USE OF PERMIT
�+NGLE RAM Llt .fl t EL.L NG
S.ri.D - LOT 17 PLAN _AC 1;OWI T DOES, NOT INCLL)DE UGCK \VM.. OP(
yt)c5�,
CUSTCA1 CONSTRUCTION 30.372.00.W
KViLCs UPATIO 318.00 .19F
C:3A1tAc.3i�iLt�ttl;'iJlt'1' ?(!t).f3t? �F'
{ TINI 71ED COST OF t GINSTRUCTITM''
no,6-2b.20
PERMIT FEE SUMVI AAR
C` 0NS'PIIZUCTIUN . Ei 101-000-4113-000 $1,273.00
'KAId CHECK FET, 101-M.11-439-318 $1.040.01
NSl`s IAMCALPE 1.01 QCOr"��1-00Q $1`ai.00
i<LW,MC;A(.1TI? 101.000-420-000
PLLP%48.fNQ 17-tF .1.01-000-419-(W $205.75
S ft<�__rqa ?c7`riom reE- RESCn t�1.1-QQ0 7.4i-0Q(t $X(16
GRADINGIT..L 1Q1-Con-�12 Q0J X40.(14
1?>1WV&i7.PER'k IMPACT FEE
ART IN .PiS. LIC: P1.A(XS-.RES.tL 701•-000-255-000 $451.57
ST rl3=1' i'Al C.�3 .13f" 1Tt�'N r'�";\ I KA`[� t�l�t CK
g S�aR wt
LESc i>M%-PA.1.D FF_`ES
$0.00
ti
Wriu., PERMIT FEE'S W1411 NO",
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Y < e
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing 0
/ pa
Compressor
Insulation
Vents
Fireplace P. .
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�rrj
Drywall - Int. Lath
�7
Final
Final
BLOCKWALL APPROV S
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
A I.A
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
7
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final l gW—
Utility Notice (Perm)
COMMENTS:
'OCT -19-2000. 12:13 WESTERW INSULATION 909-686 8786 P. 06/16
t12
:!, W� 'TE N INSTMATl N INC o
I 14211 Latham Street, Riverside, Cantortiia 92501 f
TCL (909) 686-8760 Fax (909) 686-8786
A _ INSULATIONCEIaTIFIGATE � •
THIS IS,TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH '
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE COOE,, TITLE 24,
STATE OF CALIFORNIA, IN THE,BUILDING LOCATED AT:
TRACT / PHASE: ` 'MONTECITO COLLECTION- 28776 PHASE 3A
;LOT # ti 1t7 . • r .
rSITE ADDRESS 5768 SOUTHERN HILLS; -:LA QUINTA, CA
-- -: - - -- ^ - - ------_...----- - -- . - --
EXTERIORWALLSs� -• -�'__ , .• • •
MANUFACTURER: GREENSTONE THICKNESS:. • 10.3" 'R -VALUE- R-38..
CEILINGS: BATTS LOW i
MANUFACTURER; JOHNS MANVILLE THIO ESS: 13" 'R -VALUE: R>38 '
CEILI GS• ATTS BLOW
i iN •
MANUFACTURER: - • JOHNS ANVILLE THICKNESS: 5.5' R -VALUE; R-21
GENERAL CO TRACTOR_ R . C. HOBBS CO.
LICENSE NUMBER:`
TITLE:
-DATE: ,f
IN ULA ON CONTRAC OR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
* BY: -
TITLE: OFFICC MANAGER ' r
.,DATE . OCTOSER"190 2000.'
.
- t
I,, ,
- , EMIERALD ROOFING,
INC.. ,
78-670 HIGHWAY 111, STE,
174
•
LA OUINTA, CA 92253
h.
License No. 770940
,
(760)347-9869
October 26, 2000
MONTECITO AT PGA WEST
a
` THE R.C. HOBBS COMPANY
55487 SOUTHERN HILLS
LA'QUINTA, CA.92253'
'
-TO WHOM IT MAY CONCERN;
EMERALD ROOFING HAS INSTALLED O'HAGIN VENTS AT-MONTECITO
HOMES AT PGA
WEST. BELOW ARE THE'ADDRESS AND NUMBER OF VENTS INSTALLED.
PHASE 3 -A -TRACT# 26776
LOT* PLAN#
ADDRESS
# OF VENTS
17 3-C
54-768 SOUTHERN HILLS
16
18 3-A'
54-790 SOUTHERN HILLS
16
19 3-C
20
54-812 SOUTHERN HILLS
16
2-A
54-634 SOUTHERN HILLS.
17 '
'21 2-B
54-856 SOUTHERN HILLS
17
22 2-C
54-878 SOUTHERN HILLS
17
23 2-A
24
54-900 SOUTHERN HILLS
17
3 -CR
54-922 SOUTHERN HILLS
16
PHASE 3-13 TRACT# 28776
LOT# PLAN# ' 'ADDRESS
25
.
# OF VENTS.
3 -AR
54944 SOUTHERN HILLS.
16 -
26 2-C d
54=966 SOUTHERN HILLS
17
27 2-A
28
54-988 SOUTHERN HILLS
17 J„
A
55-010 SOUTHERN HILLS
17
29 1-B
55-032 SOUTHERN HILLS
1.7
30 1 -CR
55-054 SOUTHERN HILLS
17
31 1 -AR
55-076 SOUTHERN HILLS
17
THANK YOU,
JOHN JONES
PRESIDENT
,i
y
Certificate of Occupancy �0
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform -Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction `or use. For the following-
BUILDING
ollowing:BUILDING ADDRESS: 54-768 SOUTHERN HILLS
'Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-122
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner=of. Building: SOUTHERN HILLS LLC Address: 1430 E CHAPMAN AVE STE 100
City:' ORANGE, CA., 92886
By: DANIEL P. CRAWFORD JR.
Date: 11/13/2000
Building Official
POST IN A CONSPICUOUS PLACE