9901-121 (SFD)LICENSED CONTRACTOR DECLARATION .
1 hereby affirm under penalty, of perjury that I am licensed under provisions of
•CFiapter,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
�iDate?' "r t 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:
( ) t, 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).
. 1, 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.
(.) I have and will maintain workers' compensation insurance, as required by
Seam, 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.
o.
GOLDW E«1 ,LF ATWC' 541701400
(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,
1 shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if V should become
subject to.the,workers' compensation provisions of Section 3700 of the Labor
Code,•,I,sha11 forth tt comply with those.provisions.
ate:-”. � � Applicant - � ats.�^'"""
Warning::Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition"•to'the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. .
IMPORTANT Application is hereby made to the Director of Building and Safety
fora 'permit subject to 'the conditions and restrictions set- forth on his
application.
1•: Each person upon whose behalf this. application is made & each person,at
whose request and for whose benefit work is performed under or pursuant to
e: any.permit issued as a result of this applicaton agrees to, & shall, indemnify
&.hold harmless the City of La Quinta, its officers, agents and employees.
' 2. Any permit issued as a result of this ;application becomes null and void if
work is ,not commenced within 186 days from date of issuance of such
permit; or cessation of work for 180 days will subject permit to cancellation.
I.certity that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
S g ature (Owner/Agent)'"< J J Dale.2
PERMIT #
BUILDING PERMIT�.a.,,; ,
DATE VALUATION �����,)o LOT,' TRACT 28776
2 JC'j
JOB SITE 1Sq�%%,tom tS 7 �4a. �3
ADDRESS 1 :%J 64 .3OUIT IERN 11 JL.L,
APN �y a� rel.p�a
767••l 06-0.2 9
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SOUTINERNf HILLS, ILC
R.C. HOBBS dba SOUTHERN HILLS, LLC
1430 E CHAPMAN AVE., Ste 160
53-960 PGA UV
ORANGE CA 92886
LA QL[iWA. CA 92253
(7:1.4.)633-7260 C"B.L# W.
USE OF PERMIT
SINGLE t^At41. LY TJWELIANG
LOT 6, PIAN M.*-SFD-PERMIT DOES NOT INCLUDE BLOICK WAws, OR,
POOLS. PLAN CHECK FFX R.F131iCED 7515 FOR. W -I T(Pt E 11.3SUtYME OF
SAW PLAN TYPE
CUSTOM CIONS`1'R:(iCt" ON 3,020.00 SF
PORCHWA 10 320.00 &F
GARAGWCAPPORT 865.00 SF
ES D`.t'MAT D CWf OF CON8rrR'UC'T1ON
256,468.410
PERMIT EEE SUNIXtRY
CONs'1' uCTION.FEE 1p.i f)i)��113$ i)4U $,t,.if3�3.00
PLAN Q037 ;K M 10t-00439-318 $242.44
bVISC,f1ANICrij: FEE 101-000-421.000 3111."
&6'CTR1CAL FEE i W -000-420-000 $18D,.50
F,Li NMINGFt.E 1014=419 -ow $186.50
STRONG MOTION FEE - RESID 141-000.241-000 $25.65
CrPUWING FEM 101-0004B-40 $20.00
1.fii:FfW'1'.ti 11Gt'1.fR1,WE 225•-000-443-342 $5,674.77
,An i.N'131JBi,1C.PLACES-u-sir, 701-000.155-O 3,391.:17
rR:TOiZ�►:L CrNSfir_ rt"i?OR AND PLA! CHECK$8,021
_53;
LE,SS PKE-PAWFE-9
W.ti0
TOTAL: PERWIrr FEES DUE NOW
Ss,172 i.53
RECEIPT
DATE
BY{ j
DATE FINALED
INSPECTOR
J J 11
. . i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings A
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 P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath . 01 iFIAW
Drywall - Int. Latlf
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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 41z,Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Oct -9-99 09:50A
The'DanDe'e
CoMY bn. L is 732542
ROOF/NG AND CONSTRUCT/ON
P_01i,
f�
Roofing Propos osal-
al-
it" Box 277 T/rousaimll' Palms; CA .92176
Phone (760) 343-3385 Fax (760) 343-3096
BIDS TO : JOB NAME:
THE R.C. HOBBS COMPANY " MONTECITO COLLECTION
55-960 PGA BLVD. PHASE# 1,
LA QUINTA, CA 92253 LA QUINTA, CA 92253
PHONE# 564-1551 FAX# 564-5091 DATE 10-28-99
THE DAN DEE COMPANY INC. HAS SUPPLIED, AND INSTALLED
THE FOLLOWING AMOUNT OF O-HAGIN ROOF VENTS.
�QTti
0 OF VENTS
2
17
3
16
4
17
6
16 :
7
16
a
1s
s
1s
--------------------- ----------------------------------------------------------------------------------------------------------7-----------
NOTICE
'Under the Mechrnics' lien I.aw . (Catifomia Code or Civil Drocadure Section 1161 el Set) ). any conirccmr, su6rontr ctor. laborer. supphui other Dern no help; to
improve your pn pery but is not paid for his work or supplies, has a right to enirnce. a <daim against your property. This moans that, aner a marc hearing your property
rdutd be sold by a court officer and me proceeds of the sale used to sanely the indebtedness. This can happen even d you have paid your own Coruaclor <n furl If the
Sutn:en(ractor, iatwer or supplier remains,unpaic and it legal action is necessary to collect or enhxce the terns of this centracl. lha p1 evaibnu party shall t* crititle.4 to its
reasanaete anomey fees ples all costs di suit and interest shall acc" an all -aims, which are due 30 days aflei billing of the ratr. at 18 /. per annum. The DanDee Co.
Inc. is not respons,ble foo delayscausedby weather, stoke. material shortageby delay hr nialenal suprrtn:d to rhe job or w any other delay Wy000 its Contrni Trre
DanDee Co Inc, total tiabililr under mts contract or in rt"Hgt riot is Invited solely to the amount of this amtrat t
We are filly Cgvered by wQrltmen's compensation anti ppblic liability insurance. Carriers names and policy numbers available on
request
any aneration or deviation num the a atxeve specifications involving extra cost of material or labor will only be executed upon written uiders tov sariw:, aitd will became
an extra diaryt: over the sum mi mined in this proposal. AD agreement- musr he made in writhing anti is basud art fret aCsess to building fnr direct loading from van
truaz.
Prices are based on current costs of material and tabor.'Increases or decreases, -111 ha rofleetad ac dme of signing eontrsct.
Before and or during roofing operations and the completion of rooting, The DanDee Co Inc, will not be responsible or liable for damage caused from
acts of God, such as earthquakes, thunderstorms, had or any outer weather coredidons beyond rooters control.
.0ATl;
f•.
THE DANDEE CO. PKOPOSAI. VALID FOR PAYS -
DEC-29-1999. 09:43 �.: WESTERN`INSULAT"ION 909 686 8786-P.13r19.
ESTERN INSULATION,' INC*' .
4211.Latham"8fteet, Riverside, Cal &rnia 92601 ,
(909) 686-8760 .
'+ (909) 686-6786 Fag
INSULATION CERtIFICATE
THIS IS TO CERTIFY THAT INSULATION - HAS; BEEN INSTALLED IN CONFORMANCE WITH THE
-,CURRENT ENERGY 'REGULATION, CALIFORNIA ADMINISTRATIVE CODE,,TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: , MONTECITO=PHASE 1 TRACT #: 28776 7
LOT#:
6 _
SITE ADDRESS: 54-504 SOUTHERN HILLS, LA QUINTA, CA. T
EXTERIOR WALLS; '
MANUFACTURER: JOHNS-MANVILLE THICKNESS:. 5,'/z" R•VALUE: R-21
CEILINGS
BLOW
`�
MANUFACTURER: JOHNS-MANVILLE THICKNESS: 13" R-VALUE: R-38 "
cauliGS : BATTS(BLOW
MANUFACTURER: GREENSTONE THICKNESS' 10.3 R-VALUE: R-38
GENERAL CONTRACTOR: CENTURY AMERICAN DEVELOPMENT
LICENSE NUMBER:, t
BY:.
TITLE:
DATE: r
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE N"ro-
TrTLE:
BY:
;
DATE: DECEMBER 29,1!bo
r
can t&'.o ��uV
ce ri _ _..,._
ti Y
tol La Quinta
F
Buildings and,,Safe.tY 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: 54-504 SOUTHERN HILLS
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9901-121
Occupancy Group: R-3 Type of. Construction: VN Land Use Zone: RL
Owner of Building: SOUTHERN HILLS, LLC
Building Official
Address: 1430 E CHAPMAN AVE, STE 100
City: ORANGE, CA., 92886
By: DANIEL P. CRAWFORD JR.
Date: 2/17/2000
POST IN A CONSPICUOUS PLACE