9907-148 (SFD)LICENSED'CONTRACTOR pECLARATION
I;rlereby 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 tL"3
# ALic. Class Exp. Date yip y
N 78689 . a i6et.2✓F�d.
vDate .� . Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of'perjury.that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, as Owner of the property, •or my employees with wages as their sole
compensation, will clothe work, and the structure is not. intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, 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&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:
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;
Canier' �.vv�1 1 pp _T� Policy No.. �+. ��'m!� t n.
GOLD iY Y.l�J'[ij3'�i:, i Vit�i: J•0�,
(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 provisibri of §bction 3.700 of the Labor
Code, ,si�al • rth ItMcomply witl56, prLe
o Is)q s d
D te: A,pplicant '
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_19r, inspection purposes. '
I .Signature Date'
PERMIT
BUILDINGRERMIT
. ,, 7-443
DATE "VALUATION�%t44 LOTt TRACT 1�
JO 8 SITE
ADDRESS f 1lQD�j it�adti t_B .�r�
APN �i 410-642
OWNER
CONTRACTOR'DESIGNER / ENGINEER
1 ` p.
R.C. LOBB'S bSYJiIctN fz -R S.S, LIOI^.+
1430 E CHAJINIAN AVE' STE, 100 ' . ..
:a3_VA) � ca: BL'VI)
G)RANGsE CA 't2"`
uk ()LJ1N.f'A. €'A. 917, 5 t
USE OF PERMIT
SRD LOT O,:kroLANIKP.K-TW.ii'.DOF- ►.MYE IAi6ui:,i3E KOC%, Wr' U OR
_K&N' C 1@Z'K 9.TtJAY "t`f,ON a' PP dam:)14-1p, L+ uLf "9.'Ipw Stl 4@'1"TAL
Ii.0*", AT(0 320.00 Sig
E91"01A QLD CONT OF CONSTRUCTION
256,46%eq
n,.iefmn Pro., SUMMA.� V
t; 0148`f't UCY10N FM 10l4W-4i&,WD $i1.2791.t?d)~
; y�
c��,Alz�'�� zc 101-000•1"(?fly'f.s;,.sta.
L" XC"1''R'10.YL MZ- 10.1"4204)0
P° MOV -419- OW
4` Ri ),NG MCW'KNN mit - i'l.E,10 i 101-OMN -.2414M,
-DRAT X103? F.M. 101 AW 42?A00
A(2 r IN f:'URIAC Pt.AK13 . ii 931 ; 701.000-255,000 $31) d,1.
b?�s t • x' , 3 42 111#{"A?� FES Via, j01(36r�.',
,(,err •
..
v 1-M-WI)'AL COMSTRt,JCT 014 ,AND PA, AN, C:1AR`K
LESS PRE A1DrT4T_
nlx)
IB'�,./P�A�6.J �H4.�fS�iV1�-/�• .��9S,T� 'I�Ri YN �0.7P-ii
`xv'µN'��. !\!
,
RECEIPT
DATE
BY#.,/
DATE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
ff 6
Ducts
Slab Grade
��
Return Air
SteelCombustion
Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation g&y7AL
Vents
Fireplace P..
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�� pj�
Dr#all - In L th
Final
Final
POOLS - SPAS
BLOCKWALL APPROVAL
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
// j3
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL
APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
08/18:-2000 10•:47 FAX 780 347 9879 Emerald RooPinB J
.
w 101
®® ��� Inc.
PROPOSAL
•
78470 HIGHWAY I II$ STE. 174
'LA QVIN'i'A ,' CA 92253 , - ' , DATE
PiOPCiiAL 0{
` L ie#
.770940
(76U7-9a69� -' � ,. ,•� .SJ16!°�
Yl4S I � '
r}
w /
r
._
14AMS /ADDB!$SS .,i. ��
_ _ i( JOB ADME&S
MONTXCM AT i4
A•'i11
LOTS -16
1®'--W
HO I ;IVRAGTIe MENTS1
THE ILCILCBS COMIaANY
SOUTHERN, MLLq
1.A QUTNTA CA 9nS3
t •
t ' 3 y
t. L
• DE3CRIPfION - ^� �_ _
TOTAL . •
TO WHOM 1T MAY CONCERN; - ------
-- -
:- EMEIRAd.® iRO®FI1HG HASJNSTALL;ED O ILAGIN VENTS AT MONTEC➢OT
ARE
DOMES AT PGA VENTS'
ADD
WEST.BEi,OY�'IE ADDRESS ANDNi7!�TBE6i OFINSTAL
UD.
f LOT # PLAN p ADDRESS- .
T
# OF VENTS '
-�.•..}...Si=�14'SOUTIE�iflAT"®L.LS � - -fl7' •"'_"'"'� .I
'
1fl 2-B 30.638 SOUTHERN B1TLfl.S D7
'
L12 2-C 50.638 SOUTHERN IFYLLS 17
r
'.
13 1-A -S44M SOUTHERN H [LLS 17. .,
•
14 1•9 34-702 SOUTHERN
�
i
� •.
aMY,S 17. �
...
� R
.
13 ' '•C 3&724 SOUTBUM WMLZ 17
_
a
+'
_
,116
2-9 34.746 SOUTHERN IfiLi.S 17 I
f�
iii
� � _
•
..
s
TliDr AB®VE PRICM 8P®C®1CATIONBAND OtNIDdT90Ali
—
AW4 9Ai'IISi'ACMAV AND - -
• AM MMEBV 4CMmD. VOU An AUVMR1EED TO DO 7M WMK A9 SPECD! MD. ' • .
, •
PAYMM T WILL, RE MADE AS OUTLVCD ARDV
r
.- SIGNATLRE
' w
• '' • ^"i Vit. ` , a Yi' a - y � •' _a .- -
♦ •••+•_ .
JUN -02-2000 10:59 •.WESTERN INSULATION ''. 909 686 8786 P.19i19•
ULA
'r&_%N J�C m
int
T�
INS
�W> R
4211 IAww
. lw= sts+eet, .Rive;aide,
686-8760. Fax (909) 686-8786 N
'r IlOT�SULA"!`I011T Clriz'1`II�`I
THIS IS TO CERTIFY. THAT INSULATION -HAS SEEN INSTALLED 111f CONFORMANCE WITH _
INISTRATfVE CODE, TITLE 24,
THE CURRENT ENERGY REGULATION,- CALIFORNIA ADM
:STATE OE CALIFQRNIA, IN THE BUILDING LOCATED.AT: r
MONTECITO - TRACT # 28776
TRACT / PHASE:
LOT#
SITE ADDRESS 64-614 SOUTHERN HILLS -
------------------------
- ---
- -
- --- -- --•--- -- -----
EXTE O W LLS' f
MANUFACTURER: Johns-MenvIlle THICKNESS: 5 1 /2w R VALUE: R-21
• CEILINGS: BATTS BLOW
MANUFACTURER: Johns-Menw7le THICKNESS: 13 Ai
R -VALUE:
CEILIIIIGS• BATTS O
MANUFACTURER: Greelwone ' -THICKNESS: 10.3" R-VALUE:,R-38
-- - -•-------•
---
-------------- -------:------
GENERA CONTRACTOR:_CENTURY AMERICAN DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:.
DATE: ,
SULATI N CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481.278 l `
TITLE: PRO C O MANAG
DATE JU ,2000.
-TOTAL P.19
rri a to .. ' f u - .C1,
a. ''
y 0 _.La wum
�>
c a f M^. M ta
ff t
.Building aid 'S fetyDepartme.nt 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: 54-614 SOUTHERN ,'TILLS
Use Classification: SINGLE FAMILY DWELLING Bldg.' Permit'No.: 9907-148
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: 10/2/2000
Building Official
POST IN A CONSPICUOUS PLACE