SFD (9812-145)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 iwfull force and effect.
License # Lic. Class Exp. Date
'7191.13 % Zi:2yiilG
Date ,
4ignature of Contracto�4�'-
k
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.
uOWI N EAGLE INS. N rC 476051-0.1
(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.�,,�ovisions
!aGAppli
Date ��'%.5�'cahts✓ > ! ! ''>' 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 voidif
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
I the above-mentioned property for, inspection purposes;f
Si nature (Owner/A e +t) f / ��,'—f--��-"t Date
BUILDING PERMIT PERMIT#
iR112-'14S{
DATE VALUATION $291,504.Sl! LOT D TRACT
�`�__l_tS___�I
-18919-,1
P. a. "�. B. c Sj
ADDRESS �.-+6.760 MI,�LT: FTET.�D V La,,E GE JOB SITE
xNyp Ste,• e� r9 tt��
APN .7 61.,55111, A*4
.!
OWNER
CONTRACTOR / DESIGNER / ENGINEER
2IELLY HOMES, INC.
IVELLY FiO141ES, INC,
23 C:ORPOR,A'TE PLAZA, 4245
23 COR ORAIT PLAZA, 4.215
NEWPORTBEACH CA 92660
NEWPORTBEACH CA 92660
(949)7t9-.1975 0:131,# 5337
USE OF PERMIT
%NC7L'.VAMILY 0W!LLINO
LOT 38, 11L AN SCR. SFD - MU IT DOES NMI BLOCK WALLS
0111 POG?I: PLAN CHECK FEE REDL ICM 7,%,'o FOR MfJLT1PI.E 1SSU'ANCE OF
SAM 'PI.A.N TYPE,
CUSTOM C0.N15TRkJC11r10N 3,409.()0 qF
PORCH(PATIO 754.08r,
G.ARAGF.,r'CARPORT 3.12..00 SF
ES1 I MA"TE131 OSf OF CONSTRUCT ION
291,504.5o
T'ERMff FEE SUMMARY
,ONS11'RUCTION FEE 101-011('7-411-000 $1,31.1.50
PLAN CHECK FEE 101-0004:19-318 $265.58
XlECRA'INI ^•„AL FEE 101-000421-000 $1.111.30
ELECTRICAL FEE 1014000-420.000 $193.06
PLUMBiNC FEE 101-000-419-000 $1.87.75
MONO A40110N ME - RESM 101-000-` 41-000 $29-15
MADIN''O M" 101-000-42-1-000 $20.00
iN1;!tA.S`.rRUC 1'i)RE FRE 225-000-443,342 $6,C1woo
ART IN PUBLIC PLACES • RESM 70.1-0004-55-000 $47:6.76
4
SIJ3-"1'OTA1,C,OI� 5.M IC'fl —N. �'LNL j�14AN i�HErK
$N,603.30
LESS PRE -PAID VEE S
S'
TOTe�i,16L1!2hrfTT FEFS L1[f F P11fi�'V
$8,603.30
I
RECEIPT-
DATE
BY " 03
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
Exhaust Fans
O.K. to Wrap 4t
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath Q
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lin es-
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
COMMENTS: �J
529
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)
K4�/
r •C
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 fol%wing:.
BUILDING ADDRESS: 56-760 -MUIRFIELD VILLAGE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: RIELLY HOMES, .INC.
Building Official
Bldg. Permit No.: 9812-145
Land Use Zone: RL
Address: 23 CORPORATE PLAZA, #245
City: NEWPORT BEACH, CA., 92660
.,. .
By: DANIEL P. CRAWFORD JR.
Date: 11/12/99
POST IN A CONSPICUOUS PLACE
1.