SFD (9812-160)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
'719113 8 2/29)00
�' �. ' `•
Date 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:
( ) 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.
(,,) 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.
GOLLL)W 133AGLE 1110. NWC 476055-01
(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 those proyvlslons a'f�1
Date:✓ - Applicant - -/�-- ''""' ;-� � r--�✓`-� � -
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.
Si nature (Owner/A en) i' Date
BUILDING PERMIT PERMIT#
DATE VALUATION $278,"144) LOT � TRACT �88`� 1
I^ �d La I^-
JOB SIT 1 `�-
ADDRESS 56-670 MUfR.��LEJ D Vfl LAGS +
APN
^ib1- 0A03
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RIELLY HOIAM INC..
RIELLY HOMES, INC.
23 CORPORA F"F PL ZA, #245
23 CORPORA, T E PLAYA, 045
KEWPORT BEACH CA 92660
NE WPORT REACH CA. 92660
(943,)71�a75 �'U11 5337
USE OF PERMIT
tilN(}.11A. 14A W LY� ,C31'ot/ IILLiI� G
UA 69, PUN 411R. SP -0- t;,EnIl`i' DOk:S NC�'1' .INCLidDE BLOCK WALLS
OR POOL. PLAN CHECK FIM REDIXED 7.5% FOR tN1MTIPLE ISSUlkNCE OF
�ir�1 V PLA14 TYPE.
C1;iSTONICONS'1RUCTI'C)N 3,22100V
P O1�Ci PA.T10 9� 00) SC
Cr.ARACOCAR1 OlUr '86.00 SF
ESTIMATED (.'OIT tits CONSTRUCTION
278,9t)1.38
PERMIT FEE SUMMARY
CONSTRUCTION FIX '' 101-00041�-Q00 S1j66 oo
PLAN CHECK FEC 1.01-000-439-318 $257.35
NW.CHANICAL M-' 101-000-421-000 5111.110
ELEC t,RX*AL F EH 101.000-420-000 $185.99
PLONIBING FEE 101.0130-x`11.9-000 $199.75
STRONG MOTION FEE - RESIn 101-000-2141-000 $27.89
GRADMO 1FEE 101-000-423-000 S20,06
1"NFRA°STkUCTIJ RE FEE 2.2.5-000-4.43.342 $5.993.99
ART IN Pil ILIC PLACES- Al�.`�,3IC 7101-000-255-000 5447.25
t'
n,, r
r
SU1�AWAL CONS' 1t K-rION AND PLAN CHECK
$8,509.22
LL;Sa 1-1bl'-PAID F1 l�ti
1;E3.(� 1
A
TOTALL FERA TT FEES WENONW
.58,501,22
DEC 241998
RECEIPT* ° `
DAYE
BY ,/ "✓
DATE FINALED
INSPECTOR
9 g �� ,/-:z' ;;r7 'A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings / Gf
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deckg ,�
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation / S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 14WWPOOLS
BLOCKWALL APPROVALS
- 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
S ection
Encapsulation
s Piping
Gas Test
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit o'
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 1,44
Utility Notice (Perm) Iv/ 711
COMMENTS:
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: 56-670 MUIRFIELD VILLAGE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9812-160
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: RIELLY HOMES, INC
Address: 23 CORPORATE PLAZA. #245
City: NEWPORT BEACH, CA., 92660
By: DANIEL P. CRAWFORD JR.
Date
Building Official _.
POST IN A CONSPICUOUS PLACE
1/12;2000