9901-118 (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 ► .Signature of Contractor't�--"'
OWNER -BUILDER DECLARATION
I,hereby affirm, under penalty of perjury that I am exempt from the Contractorxs
License Law for the following reason:
(,) .• 1; •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)`.
O; I am exempt under Section `,:B&RC.'for this. reason
Date ' Signature of Owner
'WORKER'S COMPENSATION DECLARATION'
I hereby affirm underpenalty' of perjury one of•Ahe following declarations:
(•..) J have.and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for bySection' 3700 of the Labor Code, for the
ppHorrnance 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.
ALU# h,F.AWL NWC $47701.400 :.
(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
workers'. compensation laws of California, and agree that if I should become
subject to. the workers' compensation provisions of Section 3700 of the Labor
Code; I. Shall forthwith comply with thosgprovisions....
Date Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an -employer -to criminal penalfies-and civil fines up to $100,000; in
addition to the cost of Compensation,' damages as provided for in Section 3706
of the Labor Code; interest and attomey's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for ..a, permit subject to the' 'conditions and restrictions set forth on his
application.
1:'Each person upon whose behalf this application is made & each person at
wfiose.request.and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold:harmless the City of La Quinta, its officers, agents and employees.
Any permit issued as a result of this application becomes null and void if
"•work is not,commenced within 180 days.from date of issuance of, such
prmite
,`or: cessation of work for 180 days will subject permit to cancellation.
I certify -that I have read this application and state that the above information is
correct. I agree" to comply with all City, and State laws relating to the building
Construction, and hereby authorize representatives of this City to enter upon
the, above- mentioned property for inspection purposes.
f:f t
Signature (Owner/Agent)
w
BUILDING PERMIT PERM T#
DATE VALUATION ��l LOT TRACTVit; tr7,
JOB SITE' y ���y �p�� ����yy 7
ADDRESS C 6-43$ SOU R i67`.,f 4 dz LLS
APN
769f
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SGUMERN. FULLS, LLC
PC. HOBBS Ciba SOUTHERN H1:LLS, LLC
1430 .F s:,:W.APVIAN AVE., Ste .100
5.3-960 PGA. BL`VT) .
ORANGE CA 92886
LA QUIN TA CA 92253
(714)6334201 5187
USE OF PERMIT
SINC
3.OT 33, PLAN 3C R -SFb- PROW DOES NOT NCl IRR ITLOCK WAIA.,1 OR
POOI.,s..PbXN Chitm FEE RE77UCFD 7_'n FOR MULTIPLE ISSUAW- (QST
SANE PLAN TYPF,
CUSTOM CONSTR:UCfION 3,•372.00 8F
P'ORC'I-LPATIO . 318.ft0 3F
GAR.ACS"CARPOR 1' 700.00 5F
`TWAT ED CQXf OF CONSTRUCTION
280,,428.20
PERMIT FEE SiJA hLILRY `
CONSIAUCTIO.N FF.F 1010-418-000
PIAN C1EC`.Iti Fffi 101.000-439-318' $260.00
MECHANICAL Ism 101400-421-000
0XICTRICAL Fa 101-000-44241-000
PLUMB1NG.F:FE 101400-419-'000 1205.7:5
STRONOM(MION'FE -REWD .101-000-.241-000 .5?8.06
.-
`11 FRA3rlZ.WTURE'FVY 225.000-443-312
AWr IN i?'I RLIC PLACES-'RES1L; 701-000.25,5-000 $45.1.57
SLOB -TOTAL CONS`:i'IZUCTIO:N AND PLAN C-14ECK
$FS,S51,�J
LESS PR.t�-PA1D F8kS
$0.010
TOT.,U., PE'R1N41T Y+'EIES DUE NONY
59,551.90
RECEIPT
DATE r r�BY
( /f�
DATE FINALED
INSPECTOR
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 S
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace,ollfl.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
� 39
0
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
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
Utility Notice (Perm)
COMMENTS:
C i� 9-99 09:501
The DanDee
ConWmk,v bw. - L is 732542
ROOF/NG AND CONSTRUCT/ON
BIDS TO:
THE R.C. HOBBS COMPANY
55-960 PGA BLVD.
LA QUINTA, CA 92253
PHONE# 564-1551 FAX# 564-5091
P-01
Roofing Proposal
P.O. Box 277 Thousai& Palms; CA .92276
Phone (760) 343-3385 Fax,(760) 343-3096
SOB NAME:
MONTECITO COLLECTION
PHASE*1,
LA QUINTA, CA 92253
DATE 10-28-99
THE DAN DEE COMPANY INC. HAS SUPPLIED, AND INSTALLED
THE FOLLOWING AMOUNT OF O -HA GIN ROOF VENTS.
-,OT# _ 9 OF VENTS
1 -
16
2
17
4
17
6
16
6
17
7
16
8
15
9
16
-----------------------------------------------------------------------------------------7-------------------------------------------------
NOTICE
Under the Mechanics' Lien i.aw (California Code or Civil Procedure Section 1161 el Seri ). any, cuntr,rmr. sithrantracror. laborer. supphel other person he h, -.Ip.; to
improve your prr teeny but is not paid for his work nr supplies, has a right to enface a daim against your property. This moans that, alter a midT hearing your propeny
rarrld be sold by a o;urt officer and the proceeds of the sale used to sansfy the indebtedness. This can happen even if you have paid your own conliuctur to full If the
SuWuntractor, lower or supplier remains unpaid ane d legal action is necessary to collect or entrime the terms of this contract. the pi evathrrq piny shall Ix: entitled to its
reasonable attorney fees plus all crests m suit and interest shall accrue an all teams. -hick are due 30 days alter bdhnSl at the nate. at id v/ per annum. The DanDee Co.
Inc. is not responsible for delays caused by weather. strike, material shortage of delay 41 malenal %tipfda:d to the job or to any other delay Wyald d3 control. rn,:
DanDee Co Inc, total lizitAilr unser rots contract or in negligence is gmued safety to the amount of this cantraeA
We are fully covered b1r wgrkmen's compensation and•gublic Ilabillty insurance. Carriers names and parlay numbers available on
request.
Any aheration or deviation hom the a abrnre specifications involving extra cost of material or labor will only be executed upun written urders ta' sarrre, inn will became
an extra diarVu over the sum mentioned in this proposal. AD agreements rnttsr he made in writNng ane to basud ort free access to building for direct loading from ver
lruik5.
Pricos are based on current costs of material and labor. Increases or decreases, will ho mn.«ad at time of t:ignirtg contract.
Before and or during roofing operations and the completion of roofing, The DanDee Co Inc, will not be responsible or liable for damage caused from
acts of God. such as earthquakes, thunderstorms, hall or any other weather condidons beyond roofers control.
PATF.
DATF
\• f Q 1
Tlff.%J)ANI)I L-' Co. — PROPOS.AI. VALID FOR 3-6 PAYI, y
DEC -2S(-1999 09:43 WESTERN INSULATION 909 686 8?86 R,.10/19
k WESTERN • IN SULATI011 , Ili C.. " r
`.' 4211 Latham Street, Riverside, California 92501
(909) 686-8760
(909) 686-8786 Paz
MUTIONACERTIFICAT9.
T
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED, IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATNE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED.AT: ;
TRACT/ PHASE: MONTECITO-PHASE 1 TRACT #:28776
LOT#: 3�
SITE ADDRESS: 54-438 SOUTHERN HILLS, LA QUINTA, CA. -
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS 51/a" R -VALUE: R=21
C LII NG5: ATTS BLOW
MANUFACTURER:. JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS : BATTS BLOW
MANUFACTURER: GREENSTONE ' THICKNESS: 10.3" R -VALUE: R-38
GENERAL- CONTRAMOR: CENTURY AMERICAN DEVELOPMENT
'LICENSE NUMBER:
BY:
TITLE: . t
DATE:
INSULATION CQNRACTO WESTERN INSULATION,'INC.
LICENSE NUMBER: 481278
BY:
TITLE: rodu on lblanaar
DATE:. DECEMBER 29,1999
�,erd Occuplanc
City Of La Quinta.
..
Building and'Safety Department OF.
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 ADDRESS:', 54-438 SOUTHERN HILLS
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9901-118
Occupancy Group:- R-3 ,Type of Construction: VN Land Use Zone: RL
y .
Owner of Building: SOUTHERN. HILLS, LLC Address: 1430 E CHAPMAN AVE. STE 100
City: ORANGE, CA., 92886
By. 'DANIEL P. CRAWFORD JR.
Date. 5%24/2000
Building Official
'`" POST IN A CONSPICUOUS PLACE;