9808-193 (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
/ 725Y24 713:1#00
Date Z/ 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 Policy No.
,�,At11.=.IRAN; :CRR. CO. P%10076001
(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
workersl,"c'ompensation 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 those provisions.
Date: if. -se Applicant -
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. I
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/Agen�l " `� Date��-./��'
y
PERMIT # CONTROL #
BUILDING PERMIT,
DATE VALUATION $259,42.6(1 LOT 31 TRACT A�<V 2
(7 (.
n ,
JOB SITE
ADDRESS 79-69:9.�dI�, A
APN r769-700-013
OWNER
CONTRACTOR/DESIGNER/ENGINEER
O.E.'s,E'Z1't-OUSIN LLC
CXIIELLUSRLSIDEIT1 ALCONS"C'RUCr'10111
5 PARK 1'1at" ZA ST C3 400
SPARK PLAZA, 91J:11'E �W9
d1fV11�T[3 CA 92614
tlt'Vj;NE s 5;n1�3
Q14)251-6100 C -61A 5072
USE OF PERMIT •';
SIAlCLk; �.t�iYll�,l� �J1NL[.I.,h;r� .-
,"I - - '1Cp, .I,GiT # 31—.. P.aWr DOIES NOT INf;L:1D4Mt C—F, WALT OR
POOL.
i
CUaTOA11 CONSTRUCT i TON 3.07,.2.* 0 0"
POPW:MPATIO 302.00 sr.
OARAC FJCAR.PORT 807.00 SF
r
atT;Atfia�?c�c�.�r.h.��.vde%•ii�e� `.6%i�.YSa�V'iy�i.��`�
G.�iJ,i4L.iY i
Y EM3.iO [' Ar,� SUMMARY
li',iMARY .
C4N,'T 1KUM, '1UN FEE, 101-004-418-000 $1,1991XI
MAN ("-IMCN„FF E 101-0M.-439-318 $9111t.43
iy1Lc"1 AN.1CAL V 1:'E 101-000,421-000 595.50
:10..WMICA.1.1�:l , 1).. 16
Pt.tTib UNO F.E1I 101000.419-000 $156.50
S x tiCJ;► f t MOTION t'FF, - 89!5ff? 1.010004414M ,V25,91
101.000-423-0100 3 U.ttn
INR(A-SIRTKM 225-000-443-342 $5.740.34
ART 01 PUB"LTC PLA-C,E.S - RE -91; 701-000-255-000 $397.86
SUB-71'0TAL r-6N�°�RUCT1C3N AN1'31'LA'N CHECK�S,t1111.2(,
x LESS l'R.E-WO FEES
$0.00
121998 'TMAL PERMIT FEES OVE NOW
NpV
' .17Y L P-1
RECEIPT v
DATE
BY t �'
DATE FINALED
INSPECTOR
1
T,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
11 DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL. APPROVALS
Set Backs
LU(
Underground Ducts
Forms 8, Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck _ 2_ G}
Exhaust Fans
OX 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 Itzezf
Final .
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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
i
r
Final -
014 Notice (Perm)
COMMENTS:
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
79-695 LIGA
Type of Construction: VN
Owner of Building: CATELLUS RESIDENTIAL
Building Official
Bldg. Permit No.: 9808-193
Land Use Zone: LR
Address:
5 PARK PLAZA SUITE 400
City:
IRVINE CA 9261
By:
KIRK KIRKLAND
Date:
9-10-99
POST IN A CONSPICUOUS PLACE
i