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LICENSED CONTRACTOR DECLARATION
y'
I hereby, affirm under penalty of perjury that I am licensed under provisions of
Cf apter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force a/effectLicense # Lic. ClassExp ate
70854
Date624 Signature of ContractorI 11 �
�w
OWNER -BUILDER DECLA ATION
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
Dale Signaturo 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:
Carrier Policy No.
P.&CIM, RA01,121INS. 4114Y.I15€l273
(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 man er o a.Yo become su4•ie to the
workers' compensation laws of Californi �V,iodBe that if 1 s,,�,�,��6ul become
subject to the workers' compensation6p ythe Labor
Code, I shall forthwith comply with th • s rt.Date: 0 ✓e II I Applicant
Warning: /Failure to secure orker 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 �ve 'hformation is
correct. I agree to comply with all Cit�,t✓d S to laws rel In o the building
construction; and hereby authorize fese atives of • Is ty to enter upon
the above-mentioned property for i ' • purpose .
Signature (Owner/Agent ���"G ate
�. -%C--
4
BUILDING PERMIT PERMIT #
DATE VALUATION LOT 1 Qi�V TRACT
Y 42'„SO _40 R�tI2s•t-�
JOB SITE
APN
ADDRESS _
81 -iii, GOLF" VIEW DRMX
762-390-M9
OWNER
CONTRACTOR/DESIGNER/ENGINEER
L78`�.C91 UX
f*D- FI OF CA4 �Y9i22dY. TiC
.16940 WN KA4'CpvTA1! AW_v frAY. 200
23 COR POIRME PLAM SUM 245
MrAIT E CA 92606
NEW01CC BEACH (7A 92660
(94 )7194Y? + CID7.# 636
USE OF PERMIT
S1?D „ LAW 40, �t±I� 911. 8�EN..MT 17OF3110T :IB4CLU171; 81.0=WAM
,. Pf ]A.PJ? OR f1R.iUWA!ts' .i1.tspRodt.C'wm Pw4 ci'ac, Pa.
REL i7Of', 3ON IVOR, ISSUANCE 01.9'ahNIJ8 PLAN °i<'YP
CUSTOM CONSTRUCTION 313I310 SP
PORCRIP.�ITIO 760.00!W
O.FLAOi'IC:faG'c1'E9br0 SP
YKRUHTIPM MUMMY
CON1;'I`ROCTIO 0. 101 -WO -4.19-0 0 $Jd71 5U
I'>t,J N CHUCK ftE 101-000-43.9'-318 $260.17
-ECHANICALS'KE, 101.000-421.004 $124,40
R1..M'1'RIMI,. ;FFA; 101-000-4210-000 $182.20
Pxs11MBI'NG "1''% 101.000-419.000 $209,73 ,
S'I'I'L+JNO N.IrJ'I'100 1 VS ,, RP21D 101-000-241.-000 $23.14
ORA6NHO PE6? 101 -000 -413 -WO $20.40
P 0�ft'�.«1�f,1�.�f�,?a-A.C`P.I?%F�. � 7• $1,F0'F.ttt!
ARTM M PUBLIC PLACES FL&,�" -270-000 1•x:4 000 $20,M1
9"t11TA-` O7"AL CC9 s,�1' 3 iT'MIdt?9 AND P'T..�M CHEC-s<
p . CJ LRIM aux FRS
$010
L 11IF"I )"ars ;011 E .�1iF1t4w
SEP 11 2001
CITY OF LA QUINTA
FINANCE DEPT. »a;
RECEIPT
DATE
BY
DATE F ALE
INSPECT
I r J
INSPECTION RECORD
r OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings �Qi
1%` _ _
Ducts
Slab Grade
JQ(_
Return Air
Steel
Roof Deck
` _
�2/� /��
Combustion Air
Exhaust Fans
O.K. to Wrapd/
F.A.U.
Framing
Compressor
Insulation
//j�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
71:i
Final
702
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
APPROVALS
Gas Test
.PLUMBING
Waste Lines
_
,�ll�/��—_
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
��/9/��
Encapsulation
Gas Piping
Gas Test
)
3/y/���i �fj�0l�✓
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)
VIA,CGC�
JUN.17.2002 09:25 1760233408! MAYER ROOFING #278;0 P.001l001
M
ij
1
Corporate Office:
P.U. Faux 462890 ® , , Phone: (760)137-9898
Escondido, CA 92046 R .ORATED I'AX: (760) 737-0350
I.ir nsa 1663581
WESTERN PACIFIC HOUSING
LA QZTIIN'TA
760-564.7022 (FAX)
Attn: JOAN
Roofing on "LEGENDS Cal P.G.A. NEST" Ph 2 LOT #40
N
06.17-02
Mayer Roofing has supplied and installed "13 " O'ha in cloaked roof vents, on lot #40
at 81-27.5 GOl..lj V11 W DRIVE,. Tile vents have been installed per !manufacturers spwifications.
Note; Exact vent locations are determined by builder
RESPECTFULLY SUBMITTED
;
SCOTT BEEC:HAM
OPERATIONS MANAGER
Mayer Roofing, Inc.
Page 1 of 1
558 Lihruy Street • Sats Fernando, CA 9!340 1.93 Orang- $beet , Rivcrsidc, CA 92502
('$1.8) 838-6064 4 FAX (81 S) 83$-4493 (909) 7tt2.060I ..FAX (909) 792-0804
M
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
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: THE LEGENDS @ PGA WEST #28838-1!-2, PHASE 2
LOT #: 2040
SITE ADDRESS: 81-275 GOLF VIEW DR. LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 R -VALUE: R-30
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PRobuCTTON MANAGER
DATE: d"AYARY 28, 2002
Certificate of Occupancy
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 ADDRESS: 81-275 GOLF VIEW DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0109-061
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SRHI, LLC
Building Official
Address: 16940 VON KARMAN AVE, STE, 200
City: IRVINE, CA., 92606
By: DANIEL P. CRAWFORD JR.
Date: 7./3/02
POST IN A CONSPICUOUS PLACE