9903-301 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
`NChapter 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
�
aA to ' r� � Signature of Contractor
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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 Policy No.
(This section need no be co p OF if the permit valuation PTCior 45928710or 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, shall forthwith comply with those provisions,,"/ f
DAe: %1 �d /s'� Applicant �W �CaX k
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,1n
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. r";
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. '
t, 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.
Si nature (owner/Agent) -�"�'�� 1'--�:�'� Date'i'�
x• �
BUILDING PERMIT PERMIT#
DATE f f VALUATION LOT�i .301 TRACT
$277iO22.80 19 2it+94-Ei
JOB SITE
APN
ADDRESS
79.499% 6 IGA
ray 6�til`i1I19
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DESERT HOUSING LLC
CAT'ELLUS RESIDEVRAL COIF{i&R-INMES,
3 PARK PLAZA STE 400
S PARK PLAZk SUTTE 400
IRVINE CA 921514
IRVINE C.A. 92614
(949)251-,6100 CEL.# 5072.
USE OF PERMIT
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SM. LOW 19, PLAN 2A.. P17 MI J DOE NO f INCLUDE BLOCK UVALL
OR POOL..
-..
CUSI'014 CONSTRUCTION 3.328.40 SI~
PORICHIP 0,10 312.00 SP
t`ARAGEICARPORT 695.00 SF
E S7't1VtNf.E13 COST OV CONSTRUCTION
i r",012,30
I'EIVOIT Ii'.EF SiM11 ARY
CONMIXTION f`Fis 101400-4.I9-000 $4,262.50
PLAN CI3ECK FEE .101.000-4399-318 $1,024,.03
All ZHAINICAL FEE $92.00
EL.EC i'IUC'AL :FFE 101-000-420-000 $206.88
P.LMiS.iNG FEE 101-000-419-000 $166.50
S'I`iR014GMOTION FE:E,-ft"SID 101 -000 -241 -MO $27."'0
t3I2.4WINGr FE1 101-000-423-000 $20.00
iN'L.IItFLS'P UCT"URE,F.8E' 225-000-443.342 Sfi,C�OtI.(30
ART IN PU1 LI.0 PLACES - IMAC 7,01-000-2,55-000 $412.56
-SUB-TOTAL CONS -M I'ION AND PLAN CHECK
ju,*SS PRE -PAI FEES
$0,010
PAID Y
• Rs T6TALx.PEITI1fY11<'EI;.,,.SD1'JE1Y0W
59,262.17
MAY 14 19aa
s
A j
4 i]
RE P + DATE FINALED INSPECTOR
1.BY
t ✓A{
INSPECTION RECORD
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 WrapF.A.U.
Framing
Compressor
_ c�
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z
Drywall - Int. Lath
C 1
Final
p
Final —GU
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 Connection
Encapsulation
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:
P.O. Box 1504
78-495 CALLS TAMPICO (760) 777-7000
LA QUIN"rA, CALIFORNIA 92253 (TDD) (760) 777-1227
July 17, 2000
Mr. Brian Geiss
Catellus Residential Communities
5 Park Plaza, Suite 400,
Irvine, CA 92614
Dear Mr. Geiss:
Please be advised of an address change for the following structure. The structure
formerly addressed as 79-496 Liga, APN: 769-680-019, Lot 19, Tract 28490-6, the
construction for which building permit #9903-301 was issued, will,now be addressed as
79-498. Liga.
Please note this change and contact me directly at (760) 777-7019 if I may be of further
assistance.
Thank you.
Sincerely,
Diane Aaker
Senior Secretary
Building & Safety Department
1