9903-306 (SFD)V
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
637252
te.��° Signature of Contractor ' •"�'+ f
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
!,.hereby affirm under penalty of perjury one of the following declarations:
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�' _ Policy No. �
(This section needed no be computed if the permit valuation isifo 1 500:00 or less).
() 1 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 3,700 of the Labor
Code I shall forthvuith comply with those provisions. /�
,pate: et.,, T%;I ale#.+Applicant/..+�11 . „(.',
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 ae;
,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 upoili
the above*- mentioned property for inspection purposes. S P
%
Signature (Owner/Agent) � , Date 4'/
uc
BUILDING PERMIT PERMIT#
f .
DATE` {�� VALUATION LOT X1903- 306 TRACT
`=s l /`r`f/y� 5305,2.22,60 45 2489".
JOB SITE'
APN 4
ADDRESS
79-495 LICA
70-700.025
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DESERT HOUSING LLC
CAT'E IUS R.ESIDENTIAL, COA'tIMNI T' ES,
5 PARK PL t SI'.E 400
5 .PARK PLAZA, SME 400
IRVINE C..A. 92014
IRVINE CA 9361.4
(�?�l9)2Si�nlOtf CBL..# 5072
USE OF PERMIT
'17
b :i: I.a :r l; -S tY,.l.Lr f ♦V L . +tVy:/
S>;'1J..1, OV45 , PI..Oi MR -GI . PLAN CMC:iv ME R66UCS 15% FOP.
IVI111.'f1 IX ISSUANCE OI: AMF .PLA.N TYPE. PERNO DOFS XOT iNI CLUI7:h
M, near MIAT I nn r
CUSTOMCONS'1}iOMON 3,690,00�W
PORCH/PATIO 3.12:00 S
GARAO CARO 011T 695,00-13F
,fes l't'dMA:'E'ED (MST i11.r' CONS T9RiX.".10N
30.5,222,6{}
P]CR&M FEE SUMCr'1 Y
CONS'1 RUCT1017 .FEE 101,400-118-000 S1,360-30
nAN CHECK FEE 101.000-439-M 1$278.54
MXCHAMCAL FEE ' 101-000-421-000 $1224.00
ELI: TRICAL FtE 101-000420-000 $227.05
PLUIVOINOI EE 1.01-000-4:19-000 $2I+1.50
STRONG Py,taffOIN M a RE SID 101-000241-000 SX52
G1%ADING.ME 101-000-413-000 $20.110
1N1.RASTRUCTUR F'EE 225$03-443"312 $6,000M
A t'r IN PUiBL:IC.P1,,.r MACM5 r't1ESF1'• 701 -MO -255-i40 $313.(1Fi
1, CONtSTRUCTION AND PLAN C1 FCh
$8,768.17
L9SS PRE -PAID fSEE;
$0.00
MAY 141999, TO
AL PER11'i1 T FEES DUE NOW
$9,763.3.7
T6 OF LA QUI N'! A.
.�-
r
RECEIPT
DATE i;BY
#
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DATE FINALED
INSPECTOR
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.,NC
INSPECTION RECORD
*;�N
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ,�
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck '
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
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
Final
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer ConnectionEncapsulation
Gas Piping
Gas Test
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 .
Utility Notice (Perm)
COMMENTS:
j ✓L C
6 -
!'
Certificate of Occupancy
City of.La Quinta
Bug
ildin and SafetvDepartment
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: 79-495 LIGA
Use Classification: SFD Bldg. Permit No.: 9903-306
Occupancy Group: R3 Type of Construction: VN Land Use Zone:. RL
Owner of Building: CATELLUS RESIDENTIAL COMM Address: 5 PARK PLAZA SUITE 400
INC
City: IRVINE CA 92614
By: KIRK KIRKLAND
Date: 11-22-99.
Building Official
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