9907-395 (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
G:�i1�2 ,'� { G�2rtrif2iri
Date ' ��� Signature of Contractor/ -751,
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 :i!�✓ �� El (J..ran nr- Policy No. tymn aanow+
21V A'l1J. 1,LV J. 4+1, aJA• ! �- 1'v •s .+3.iAi/
(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 diose provisio 20s. '
Date: ��"'! � ���� Applicant J~
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 totheconditions 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. Lagree 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 puIFposes.1)
Signature (Owner/Agent)./_01 �•^--- ' l��L`"'�f '� Date
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BUILDING PERMIT PERMIT
W17 39S
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DATE CJfj�'' �VALUATION LOT TRACTJOB
SITEt
ADDRESS 79-;265 LIGA
APN 769440-024
L� �B
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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CI7lAUSA :Ct ,J{I►►AI2rINC.
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S PARK #''c.r94tICi:40ti
)k-LlIN t -A ii2614
IRVIN)s CA 9266
(9017311.61M r':RIA, 150T)
USE OF PERMIT
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RECEIPT
DATE
f
BY
DATE FINALED
INSPECTOR
(!
INSPECTION REG: RD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
- ()- CEJ
Return Air
Steel
Combustion Air
Roof Deck
..7 oo
Exhaust Fans
OX to Wrap
Framing
ti
— W
F.A.U.
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
Final
A1C
Final - 5 v _ �%
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
Q
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
r
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
'
Final
Final r
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) - ot
COMMENTS:
CITY OF LA QUINTA
�F aUILDIN'& SAFETY DEPARTMENT
OF
777-7012
DEC 2.9 19gySPECTION REQUEST LINE
777-7153
0,,F. MESRTIOUSING LLC
Contractor C'ATFl.l,lTC RF.CinF1Y-TIAr. CONST
Permit Number 9907-395
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-165 LIGA
SFD :j, IT 601 PLAN 2B-G1.PERMIT DOES
NOT INCLUDE BLOCKWAL OR POOL
TYPE OF INSPECTION DATE I INSP.
FOUNDATION & SETBACK - -c--A
FOOTING STEEL I C -e- x___ I��
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST Y
HEATING & VENT - A/C
FIREPLACE
BOND BEAM
O.K. TO WRAP CVV
GROUT ❑ 4' ❑ 8'
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
,POCYLtENCE & GATE
rSEWEM SEPTIC TANK S
FINALS-
ELECTRICAL
INALS.ELECTRICAL _
PLUMBING
FINAL GAS TEST - C,
HEATING - A/C /
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
4—
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
MI®
Certificate of Occupancy
City of La Quinta
Building and Safety Department OFN
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
79-165 LIGA
Type of Construction: VN
Owner, of Building: CATELLUS RESIDENTIAL CONT
Building Official
Bldg. Permit No.: 9907-395
Land Use Zone: RL
Address:
5 PARK PLAZA SUITE 400
City:
IRVINE CA 92614
By:
KIRK KIRKLAND
Date:
2-5-01
POST IN A CONSPICUOUS PLACE