9808-207 (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
72.424 E 7/3uliU
)Date da. -Irl 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
permif.is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
A1%fNl;U(_`AN 1NS, CO. L3Vi-00",60. 00
(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 3700 of the Labor
Co6e, I shall forthwith comply with those provisions.
pate: !f-• i , . a<' 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.
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.
)Sig ature (Owner/Agent)
BUILDING PERMIT PERMIT I/ CONTROL
��IiUl3.2t1"!
DATE VALUATION LOT LOT TRACT
&
ADDRESS /9'613 PONIO
APN 69••7v4-019
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DESERT HOUSING LIX
CA'C'ELLUS RESIDENT AL CIONNS -RuC rION
SPARK PLAZA400
5 Pr11tK PI.t'�.Il, S1II'I is 400
I1tVrNi r CA ^ '92614
W -VINE CA 92614
+;710251-f100 C91.. x()72
USE OF PERMIT
SINGLE F M.11 Y 3:1Va EL—T ING
l
SFD - Xk-!• Z i.O7.YizM - PORMIU DOES NOT INCLUDE '61.ieC<K ii+ALL
OR POOL. PLiVN 04,20k' FEE 12MUC93 791u :t:OR MULTIPLE ISSUANCE O
s
CliS`i%11'CaNs`fiViCTION J.861.00 Sr,
Pi5w:-k P,vTIo 312.00 S
G..kR.A`.F,JCA_RPOR`1" 695.00 S%'
E,S7"UNLAT Iry CWT' OF�'S3NT111 'CRUICTIO�'
3'8,5 ; .50
CONTSTROCITIONFEE 101-00-418-000 51,406,00
Pi .A14 CHECK., HF. 301.^0.0()-�39-x13 $2$7.05
MECHAMCAL Flits SI74.00
ELEC fRICAL FU 101-006-410-000
:E±1„UA133:NF {aF. 111.1-000-1.419.000 $2:1.4,50
T RONit llgO`1' ON FF,Ef' - RESID 1014}f)0••24J 4_)00
G1:P;lJING FERE 101-000-423-000 $20.00
INTVRASTRUCTUI.el FUE '225»000-443-342. 96,00O.CK)
ART W 1%CII3LIC P:I,..&AF.3 - KLSW %01-000-•25; -000 35�P•36
R
,
T. 'SU3-•'I:�JY% .L C0NMUCTION SAND :PLAN CRECK
$8,862,80
- _ a LESS PIL,:-IACD FEES
$0.00
NOV.12 1998-T(VYAI,,.PEJW '� E.% �ar'� NOW
RECEIPT
DATE
BY K” '
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _/_7__
Underground Ducts
Forms & Footings 7 •9 GL 4.
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 2 t
Exhaust Fans
_
O.K to Wrap
F.A.U.
Framing _ (,jG
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath tg
_
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
0. K. for Finish Plaster
Sewer Lateral _
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
_
Gas Test -7-
Appliances
Final
COMMENTS:
Final p
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
c
Final
Kltpity Notice (Perm) '�`�f j
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: 79-613 POMO
Use Classification: SFD'
Occupancy Group: R3
Type -of Construction: I VN
Owner of Building: CATELLUS RESIDENTIAL
Building Official
Bldg. Permit No.: 9808-207
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