9907-213 (SFD)VA
LICENSED CONTRACTOR DECLARATION
I heresy 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
637232 i i U%i z3r 2iti
Date n - QQignature 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.
( �/ ave 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.
f1 i✓!'V e , Yr, itl'< nri. f ll.• e^+t•I'. A efvlc--
Ai411J11e-f.,v,), �,•y=r, S,,,•i' f a i5�'1: !-n,/!
(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
Code, I shall forthwith comply with those provisio s.
Date: �&plicantr
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 inspec ion purposes t
Signature (Owner/Agent) Date
BUILDING. PERMIT PERMIT#
i
®� ,2000 VALUATIONS 124.336.30 LOT Irl TRACT t� txilfi I }
ti
JOB SITE
APN
ADDRESS -C 7 ,,.k.;L•E
64`)-CIJ9i•t1Llt
OWNER
CONTRACTOR / DESIGNER / ENGINEER
rC'.1 '/'C11t IQ 13t: (!1'i'Si;Arf` At r -r -'1A 41%i 1' 71'{9174`
7wrf i+11Ic• ) j.1kZvr%trw"I l f10A.1 siti t!\i P111 1. [+
itl�i�la, 1!IL 1*%ZA, S*Uill, 400
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IKVlNH GA 920
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USE OF PERMIT
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C0.N,S'.CRU(: #.'IC')'N PEN lS 14VO-418-ODii $727M11
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EV0r 4JPtiK INLP A(:f')r'KH $1 I'/.tr?►
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$ J6.9b
RECEIPT
DATE
BY,-
D T NALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
_
Ducts
Return Air
Steel
Combustion Air
Roof Deck aI
Exhaust Fans
O.K. to Wrap z r-
F.A.U.
Framing 3� �+j
Insulation
�-�,
t.'a
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
PC£�S l
Final
Final ?�-t
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 0-1
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. c.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
UU -I,' -L;Ui i U. Jam. f L) 0 j _ J. -I U b
1J-JUV.L1:1 11'�D
'r r -r r 'r ry
EE R I N
I �l C A L I F 0 R N I A •
E-MAIL TO SUPPOR7(@,GOUVISGROURCOM SALES(�GOVVISGROUACOXf
CWFORMA
'PA-wil'Amr 10 1001
J�
%Yuy Cai —milichaell
kileseirt Cide-8 DevelopilieTai
/8-600 Highway i i i
Main Office
La Quinta, CA 92253
Re: Miraflores
Plan Lot 44
Plan 2 Lot 45
PI -An 1 TM AA
r;-4kJC_ U I
Urldr IVII. x111111 llitca.
-this letter advises that we have observed the structurai requirements that are visibie
during construction at the time of -our site visit-
GouvisEngineering believes that the as -built construction at the time of our visit is in
general conformance with our structural plans and relevant correspondence issued by
oiir office relating to the above referenced dwelling.
This report is understood to be an expression of e%niviion by this.office, which
is based on our best knowledge, information and beliefs. As such it consists of a report
for only structural elements (as above outlined) and is neither a guarantee nor a warranty,
expressed or implied for other trades or requirements of subject dwelling.
Respectfully Submiq-041�1,'_).f
GOUVIS ENGIN f
(4
No -C38276
UP. 3-31-01 1*# V -
Hattie Vi ova 6
President Project En.-ineer
SJBJr;,1.JU-
Certif.,20510
GOUVISEENCINEERING GRMTar MALReINIES WMH offirCES1X-D C I ME: ," ,W.
4400QuFusDPiYE SufTEA N_rivPoR7*BEAcY. CAUFORNIA ' 92660 NIM752-1612 * FAX(30401752-5321
2150 FAST TAiiQunz C,4,vyov, SctITE 9 s PAW,5PAPNGS, CALIFORNIA 92262 • (7601Y23-5090 FAX(760)325-2863
FIELD OFFICES 14NDrroo PLEA-UNT01V INTERNATIONAL OFFICE- V1,ETNJXf
V,
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: 47-845 BOUGAINVILLEA STREET
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group:
R-3 Type of Construction:
Bldg. Permit No.: 9907-213
Land Use Zone: CR
Owner of Building: CATELLUS RESIDENTIAL Address: 5 PARK PLAZA, SUITE 400
COMMUNITIES
Building Official
City: IRVINE, CA 92614
By: GARY HARTMAN
Date: AUGUST 1. 2001