9907-393 (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
0-17252 L' —02129/201
Date •� ��^� orf 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:
( ) 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 Mfr+ [r,a rtr, Policy NO. ria acn'+ar.
R0 e AL &N.,, CO. Or i s �c'14tr..c.
(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 370.0 of the Labor
Code, I shall.forthwith comply with those' provisions. !
Date:
'%�:•rc}¢ Applicant•
��
Warning: Failure Ito 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. /.
Signature (Owner/Agent) �' ' '``"''^^`4J' -� - Date
BUILDING PERMIT PERMIT
!M17-39.4
DATE�f/1 f VALUATION LOT LOT 4H TRACT Zdix?.c:
A _
JOB SITE79-2.89 ,LICA
�c•
APN 1619400110212ADDRESS
OWNER
CONT�R^ACT.pO�R / DESIGNER ENtiGINE1ER
[+�• q 4t 1C�T �+ r
DESE. ii•", I i.E_7i S i� G TIC
i/
v[ ��Y
LA W F:. a..1I .IS RI'S1 )E �RA1, C\., �.� Si 1C.
5 PARii. i' .4V...A, SCI's 400
; f'11.RK PLAZA, SUM- - 4100
1k.VINE CA. 42614
#kVINH CA 92614
(940'Ia5S-t; IM (i.il.#! air.
USE OF PERMIT
LI\OLF PAMIL,I*DWELLR4G}
SRI) - LOT 58 PLAN NIR -02 t1z ika DOES NOT INCLUDE BLOCK
WALL 0A IN )OL.
C US` ONIV1 C'ONI i RU 11014
;�,:/kc"lCtPATio 316,00 Sr
(JAI<AGH/CAKt-X KT 763XI S1•'
f.'9�'YMi.1. `Y`Y.`iCR G`V'1i[3'.P`9Y.� R'�fhM1 Kf':'i+:iR'rA'YltiM7.
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911 14v Ah!
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17f, A!d .� a>it;�rt., 'F� l f 1 �-{jiii'1-LIAR•-''l i �2 �;2� 1 S<I R'7
UE,CMICAL FIEX $235.03:
P'IAX0131M0 FFE 14-0044).?t-OW S2' i.<' r
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rt,i Z-' TAT Ct`)l+ j 'j'1; lfji'tQ t1wL Nf AN 1T!iFC_
lk� 117(191
USS Pff. MID EEL-
5't)T AL PERMIT FEES 11511+. NOW
:"5,676.91
RECEIPT
DATE
BY J�
DATE FINALED
INSPECTOR
�J +
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
drry
Underground Ducts
Forms & Footings
Ducts
Slab Grade
ReturnAir
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing-
G- GcJ
'L
F.A.U.
Compressor�f
_
�-
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
! 1
iaj�
Final
d
Final
BLOC Al L APPROVALS
POOLS - SPAS
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
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 1,2 -O U
�'
Appliances
Final
COMMENTS: / ,p
�•t7@ 6iT� �� fp'�r /�Oa
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 p
Utility Notice (Perm) - �- G�
s C.CIT� OF LA QUINTA
Lo
cF oo BUILDING & SAFETY DEPARTMENT
F
7
-7012
INSPECTION REQUEST LINE
✓,�pT. 777-7153
OwnerV.- DESERT HOUSING LLC
Contractor C'ATE i ITC RESID TIAi CnNST
Permit Number- 9907-393
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS .79-209 LIGA
SFD-LOTx58.PLAN 3BR-G2 PERMIT DOES
NOT INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION ,. s,�>
ATE INSP.
FOUNDATION & SETBACK
— -�
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL
ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
30 -
GROUT ❑ 4' ❑ 8'
FRAMING
— -c' ig4t
INSULATION
PRE -ROOF
COVER NO WORK UNTIL
'DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
HAS BEEN SIGNED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
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 following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R3
Type of Construction:
Owner of Building: CATELLUS RESIDENTIAL CONST
Tem
Building Official
79-209 LIGA
•Bldg. Permit No.: 9907-393
VN Land Use Zone: LR
Address: 5 PARK PLAZA SUITE 400
City: IRVINE CA -92614
By: KIRK KIRKLAND
Date: 1-24-01
POST IN A CONSPICUOUS PLACE