9903-299 (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
T3
ZeA
��7 ' 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:
Cartier Policy No.
, OYAI lid Co. 01 ; �� • 4rr� 7
This sectionot
(n need be completed if the permit valuation is or`$10d.'00 or less).
i ( ) 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 phould become
Subject to the workers' compensation provisions of Section 3700 of the Labor
Code shall forthwith comply with those,p`rovisions. ,Z' / 7�
Pete:'S'/e-41—'�tApplicant �s�c.-
OF ti
r.
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
r & 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
yt.habove-mentioned property for inspection purp6ses.
gnature (Owner/Agent) - y - -. '` �- A Date
,• y
+BUILDING PERMIT PERM'T#
J,I JI}
DATElY"C I VALUATION LOT 9903-x99 TRACT
JOB SITE
APN
ADDRESS
OWNER CONTRACTOR/DESIGNER/ENGINEER
DEART HOUSING LLC CATELLUS RESIDENTtA]. COMMUNITIES,
5 PARK PLAZA, STIs 400 S PARK. PLAZA, SURE 400
IRVINE CA 92614 ERMINE CA. 9'2614
(949)2516100 CBL# 5072
USE OF PERMIT
9M. LOT# 211, PLAN -29 PMN41TD0E8N0T 1NCLUD)2 ET.OM
WALL OR 1"1001—
CUSTOM C:ONSTRi.1 TION 31690,00 SF
PORCt:3(PATIO 3121.00 SF
Gr1RR.AM"r-AR:PORT 695,00 SF
Le! STIA" ED COST OFCONSTRUCTION
3115ji 2.b0
PERMIT FEE SUMMARY
CONSTRUCTION Fly01D 000-418-000 $1,360.50
PLAN QWCK FEE tp3-000-439-31$ $,1,114.15
ik W RAMCAL FE'E 101-00fpl0-421-010 $124,00
14_L't'fXICA1. YtV . t0.1--W)0-41V-V00 5222.7.05
1�,11i1tf.f3lNG FRE 101-000-419-000 $tel-d.Sf�
'ERf.)1 GY NICYflON FEE - RESW 1014JO-241-OW X311.5'2
GRAO G f7ER a 101-000-423-000 s2�:oa
tNl RArS' RUCi t'; RE FRE 225.000 443-342 $6,0m.00
ART IN PUBLIC 111,&CES a RESW 70:1=000-:2 5-000
t
t� : CONS•tIr�,r>u tMIN .AND PLAN. CHECK..
$9,603.78
t)r✓
LESS PRE -R M FEES
�
$0.00AGO'.
1 a
INV
' TTL VERI�.0 > f CE S DUE i\1ONIT
59,603.75
S
lj�,'1
RECEIPT
DATE
BY t
DATE FINALED
INSPECTOR
NC
INSPECTION RECORD
l OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
(-
Ducts
Slab Grade
gel,,
Return Air
Steel
Combustion Air
Roof Deck
,—
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
e• -
Compressor — G�
Insulation
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final112.2-1- /:?�
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
_ G
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- —77
Encapsulation
Gas Piping
Gas Test
i 2-- 13 - I
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:
�1 S
Certificate of Occupancy
City of La Quinta
Building and Safety Department OFTM
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: 79-542 LIGA
Use Classification: SFD Bldg. Permit No.: 9903-299
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: 12-21-99 r
Building Official