9810-182 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
ll.-.. Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
- .
C14 LU *%, ,`t Professionals Code, and my License is in full force and effect.
O =)M. License # -y qq+•3 ti lLic. Class Exp. Date 7 q��
w L !2542 ,: t00
Z r` ate --��� Signature of Contractor ��� �<-
ON Q—✓—�
COD
J U C:) OWNER -BUILDER DECLARATION
ILLI Lu I hereby affirm under penalty of perjury that I am exempt from the Contractor's
F- a License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wages'as their sole
compensation, will do the work, and the structure is riot 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
LO
N Date Signature of Owner
ON
0)
d Q WORKER'S COMPENSATION DECLARATION
p 1 hereby affirm under penalty of perjury one of the following declarations:
Lo r � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w L= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
C0 Q U ( ) I have and will maintain workers' compensation insurance, as required by
U
O Q Section 3700 of the Labor Code, for the performance of the work for which this
F- permit is issued. My workers' compensation insurance carrier & policy no. are:
z Carrier Policy No.
cb ='i AN+i1IRMV•1 LN -S. Co. L3YX30 7t,C000
J
(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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Ate: -/, Applicant
Warning: Failure to secure Workers' Compensaflon coverageis unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety 9
for a permit subject to the conditions and restrictions set forth on his�h
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
�\ any permit issued as a result of this applicaton agrees to, & shall, indemnify
�^Vip & hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
' correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon ,
the above-mentioned property for inspection purposes. t
Signature (Owner/Agent) �j
BUILDINGPERMIT PERMIT H - CONTROL /t
DATE i j - VALUATIONS'.206,887,XI LOT 42 TRACT K� 1598 98
JOB SITE[ '79-i5_544 CE 7iJUX0
APN
ADDRESS
OWNER
CONTRACTOR DESIGNER ENGINEER
r
yYYspr AiVbfe c
Ct+4{S RiSYZEV.+IL COpSSMT.IGN
akvi., PLAZA b'TE 400
S PA:tt.fz. PLAZA, OU M11, 400
1I �i 111 UA. IM14
IRVINE CA 92614
USE OF PERMIT
S1 NCYIP P:A.id1iL DWV E,+.,i.IN6
SY-D, LOT 4 47» PLAN. 2A, f'�itMIT DOES NOT ING`LUM.' 'f33.WK WALL
OR POOL. PLAN CHECK r4s1i,it0>UC1,09 Lit' 775%u.FQfk?CUiaTIls X MisSUA ?C:E
OF SAAMM PLAN ME.
i llaxial C10NaI"RUCT CW1 a,458.00 SF
fPC"1st', H11?fif (0 267.00 SF
0ARA00CARY01-Cr 605,00 31z
MUNIA J�`r ED COX;` OF CID -N ' 9 RUC,' ION
206."77-30
C0f4 3`i'1tE51.. x113N FEF 14X)
Pr rl.NCi.Wf'K-:('`}'F. 1I?1-1fif}-.3 'J'lyli R?flei.$!.
f4XIC'1t2_WAL I'04 101-000-4!20-000 Sb.5.63
i?i,tJNvj6:E 40 FEE 10.1-(M-419-00,0 $161.25
xR owj fro{► a srllV FAN?. - 'R1?t%'ai� 101 _c? -( 4 f -0(Jtl ^t1.69
X11'.1?Irdt3 't 3 i,1i1�Qc'�t1 � :3 OciO, > L
fW RA:37` UC: (ME FP.Y,. 225-000-443-342 4p515.uH
ART fN P0.13LIC YLLACE t _ RKS&D 70J,OW-255-01)(3
lit-
7-,-
�StJf3-1 aisA.1.0 t�N ti'.T'�4+C"��1N .A1�31 ky.f,tli�1 CH}'iC'1�'
$h,rfj m
NOV 0 9 1998 USS PRE-PAID,PEE-S
ai�.QO
_2
a
RECEIPT" ''
DATE
Byk f
DATE FINALED
INSPECTOR
I
11N
INSPECTION RECORD -
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
L
Ducts
Slab Grade
C
_
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
— Cj -
I:
Exhaust Fans _
F.A.U. cn
Framing
_z
2 - `(
Compressor �---c
Insulation
L l
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
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
-02
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Sewer Connection
-1
Pool Cover
Encapsulation
Gas Piping
Gas Test
G
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
f '.
Final
Utility Notice (Perm) G
Certificate of Occupancy
City of La Quints
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:
Use Classification: SFD
Occupancy Group: R3
Type of Construction:
Owner of Building: CATELLUS RESIDENTIAL
Building Official
79-555 CETRINO
Bldg. Permit No.: 9810-182
Land Use Zone: LR
Address:
5 PARK PLAZA SUITE 400
City:
IRVINE CA 9261
By:
KIRK KIRKLAND
Date:
9-10-99
POST IN A CONSPICUOUS PLACE