9907-400 (SFD)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
u�rtSl � �
Date ,•) ��'142 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:
( ) 1, 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:
Carver Policy No:
110YAS. 11' & C.O. OV 1 T`:'{:.15 `223i
(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 fo hwith comply with.those provisions.{ /
Date: /'1 /. 3 . 3 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. j
Signature (Owner/Agent)%f � +- A` f " `'`- Date 4
id
BUILDING PERMIT PERMIT#
DATE}�jVALUATION] LOT ��� TRACT
t:k.))Y
JOB SITE
ADDRESS /9t -J d i (rEyt
APN
Ai11.7- 10744326
OWNER
CONTRACTOR / DESIGNER / ENGINEER
VIr1.1Ell, �• �.€/•1�C1X4r! 1 1 r,
Ot—A ►•J♦ V t1 i 1\.a Ir Ili.
C /�TT:1 } t 0 �? L.: ]IT�i.'kFf'l�i VNICC
f a 4• ♦ .`/s 04• 1 eil . J l a• Ial� a ., 1.. V.
3 PARK PU%ZA 917 hint
S PARK PLAZA SWIM 400
ERVINF CA 92614
11LV1NE . ; CA 92614
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USE OF PERMIT
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DATE FINALED
INSPECTOR
V
a
INSPECTION RECORD
OPERATION
T77DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR.
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-Grr
Ducts
Slab Grade
Z
Return Air
Steel_
Combustion Air
Roof Deck
11;43—
Exhaust Fans
OX to Wrap
(j
F.A.U.
Framing
- d
Compressor
Insulation
Cp
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
G
Drywall - Int. Lath
Final _ p
Final - �-
BLOCKWALL APPROVALS
POOLS -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
-� f -
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
17
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
7Z -17 c) U
Appliances
Final
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 .Qt
Utility Notice (Perm)
COMMENTS:
GO-/9--va
CITY OF LA QUINTA
�F v BLAtLDFNG AFETY DEPARTMENT
OF TNF' .45 r" 777-7012
DEC 2 9 1�NSPECTION 99 REQUEST LINE
Owner DTS=- IfOUSING LLC -
Contractor C ATF.T..T*:YTC 72F:,gjpFNTl,%1c
Permit Number ..9907-400
POST ON JOB IN CO.NSPIC000S,PLACE
INSPECTOR MUSt SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-121 LIGA
SFD4;OTi`,0, PLAN 2A-G1.PERMIT DOES
NOT INCLUDE BLOCKWAI, OR POOL
TYPE OF INSPECTION. DATE. INSP.
FOUNDATION & SETBACK
' FOOTING STEEL
MAIN GROUND SYSTEM
I GROUND PLUMBING tl0 7'
PRE-GUNITE
i DO NOT POUR CONCRETE UNTIL ALL ABO E HAS BEEN SIGNED
CONCRETE SLAB . - -G
JOISTS & GIRDERS
ELEOTRICAL GROUND WORK
I
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST '12
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
! O.K. TO WRAP
1 GROUT ❑ 4' ❑' 8'
FRAMING
INSULATION �d
PRE -ROOF p-..
COVER NO WORK UNTIL ABOVE HAS BEEN. SIGNED
DRYWALL INTERIOR
(}
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
SEW R SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST.0
HEATING - A/C
,•
HOUSE NUMBERS:
JOB COMPLETED
TEMP POWER
I
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
t.
Certificate of Occupancy
City,of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Build divandes
certifying that, at the time of issuance, this structure was in compliance with the various
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-121 LIGA
Bldg. Permit No.: 9907-400
Use Classification: SFD
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CATELLUS RESIDENTIAL CONST
Building Official
Address:
5 PARK PLAZA SUITE 400
City:
IRVINE CA 92614
By:
KIRK KIRKLAND
Date:
2-28-01
POST IN A CONSPICUOUS PLACE