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9810-179 (SFD)U) (V W O M W r o Z r c(OOo F— (D W w '1_ I- a U) Z L0 N ON U °) a- Q `rHIr 0 XW — 0JQ mUU O ��H ,It Z_ ob :5 �a Q J LICENSED CONTRACTOR DECLARATION I her 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 725.124 iJ V31 A) ✓bate // 9 � Signature of Contracto���— 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 ,, y C r. V Policy No. E .'ii1�L:i.1��:iro:,2v,,, Co. ��C,1t?;fii130{t (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 Cdje, I shall forthwith comply wit t os provisions. ----'' ✓bate: 1174 g� Applicant-�? 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. I<Signature (Owner/Agent) `rte Date PERMIT#CONTROrL# BUILDING PERMIT DATE VALUATION S200e"O.Xt LOT ij TRACT #� 91 11� !�5 V�i. ADDRESS 79-5585 t,`i!.i8�INO JOB SITE APN 76i'9 -4i /0A),28 OWNERi CONTRACTOR /DESIGNER;/ENGINEER 'SETRET iv i���� � il1��A rG iC�T(0`1_11_616t +%Li �iwio T1Cf% 5 PARK PLAZA M3400 517.t RK PLAZ& Sif.fi.t+~ 400 1N..V1N!", CA 92614 €kV]N.1 CA 9201.4 d7141125t.6100 CIRLi€ 507 USE OF PERMIT SWOLE 411UV .1. WRLL. NG --D, LOT 4 3-9, PL raN1j. K. ft lTT 1' OFiS 't<iU'i :iN LuAi�li..£�.►..00K WALL Olt i'CicX, Pf..AiN t;fiEt."K FEE 12i:13UC f1f.i 8 Y 75afi,'VOR, MULTIPLE IDLE ISSUAINi wiz OF .SAIY i PLAAf'i'1'P . cusi,om cows'T`Rucvoiq C,458.00 SF P0.AC[WA7 V0 247.063F G. MAO-WCA{2, ORT 605AA1 SF PCRMIT YAM, SUMMARY MARY C ONIS f7F O C' .ION n1r 101.-000418-000 $1,014,00 n,1,AN CHF(;K'VPF 10140)-434.318 �Gof,Ri NT C� ANICAL rIz Iia._0010-42 1, 0 $91"1100 .a &.i CARTCAL FOX 10.1di00-�idi3�0Ciu $1.55.641 PLLWOINO.1 KIM -1 103.-©W-40-00() 't`RO'NrrMnT3.d)NF'.�.-REWD 101 -MI -241 -OW $20,69 C:ttAOING �'1.:i' 101-000.423-000 $210.00 t1 E testi 4 iii .1'011 V L "i;',5-Uf ift-11,43-342. ART 1.I'4PUBLIC PLALi S- kE31C 701-000-255-000 � '• ��tli .�" i< ,J CONSTRUC'1-ION AND PLAN CHECK 2.66 LESS PRIIP.AITD FEE -ES $0.030 Nov 0 9 1998 �yy p �s B, y� p y p �f y� `t/�`�} f�L�0.AI,P G.C\M99,,f.�6:�.S:AS DU F, NOW � y� Q Jp !1 .F*,51.L•.66 RECEIPT DATE BY it DATE FINALED INSPECTOR a' I f-1 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs L� _ Underground Ducts Forms & Footings .. _ Ducts _ Slab Grade Z't _ _ �L Return Air Steel Combustion Air Roof Deck 2 . _ Exhaust Fans O.K. to Wrap 3� ��( 2771 F.A.U. _ �7 i Framing (�— Compressor Insulation _ G/ 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 1-12 — �J �/ Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral -3 2� Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Law Vottage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power r Final 13tiiity Notice (Perm)—( Certificate of Occupancy City of La Quintal 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: 79-585 CETRINO Bldg. Permit No.: 9810-179 VN Land Use Zone: RL Owner of Building: CATELLUS RESIDENTIAL Address: 5 PARK PLAZA SUITE 400 City: IRVINE CA 92614 By: KIRK KIRKLAND A4 A1.1'114 1-X11,4141 Date: 9-21-99 Building Official POST IN A CONSPICUOUS PLACE