9905-234 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Imo— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 U) Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
O 622 B tiJ2�l2(}t
oZ � ate Signature of Contractor
CO 0.�
J U C) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ License Law for the following reason:
Z_ ( ) 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
M () I am exempt. under Section B&P.C. for this reason
N Date Signature of Owner
ON
C7
2 Q WORKER'S COMPENSATION DECLARATION,
C:) Z I hereby affirm under penalty of perjury one of the following declarations:
U-) O () 1 have and will maintain a certificate of consent to self insure for workers'
X LLI LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ( I have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
c^o 5 RMAL IMM. CO. Or r P'):<.:19 a,+= 7
0
(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 ovisions of Se tion 3700 of the Labor
Code, I sh 11 f Orth ith comply with those �o gig
D 'E W 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
4 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,: a
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 bove-mentioned property fo i pection • L{�poses. p
ignature (Owner/Agent) '� Date,/
PERMIT #
BUILDING PERMIT
"16-234
DATE VALUATION 5114,993.00 LOT 13 TRACT ?3601-I
ADDRESS 79-835Cei,. .S�.A. � �a�i.t�'�•i
JOB SITEOWNER
649-0.3'Q� 020
7�_
CONTRACTOR/DESIGNER/ENGINEER
CNFELL S ):F .SID.NT);P.;., t:Oi++ IMUNt`t'1'E;S.
IN'( CKI'ELLUS PNESAUDEI TIAL, COMIZsI RUC"tON
`+ PA FLK PLA" SWIG L•. 400
, .PA.i;ZK PUNZA, SI.iiTE 400
IRVINE C.fl 020-14
MINE CA 420) 4
Ag) 51-6100 OW! 072
USE OF PERMIT
>190 L FAWLl FAVE LUNG
,,.F0 . ,P.LA3v 2ARt, .LOT f 3, i�l~4c�,ii ' .I tC't1 $ S1C+ ` s'fibCLLT �3T.t�C�s:
WALLS tit!. 4.1001..
'FrC.AC'i' i:OT1S.i'Ki'C) rl ION L914.00 ^W
VIORS:Tii' A IO 120.00 8
t`3Altt t3WCARPOR.T 483.00 SF
tsa�'i rt.It n�,� r' A >L:�yigrFiaa v ��1s0;i
1."'"301
C0NSI�tUCrION 1-13H 101 -0W -41W -OW S692,00
PIAN C HIErX >iTE
a1iL-CHANICt'1;..IM" $66.30
i'mc uCAL MI. - tt3I-C�-�t2a0o0 st2�, t
111A>v18INUFEE ±o►�0c -3I� nfJt3 sf�a.tx�
,�'7'h'C14v t4if_y'.i'1CiN{)()t)) S itj
t3RADINCr FEE i01-000-423-000 S20.U>7
WRASTRUCTURRED3 225.000-443.3.2 S21.351.1 3
rlRT (N i?LWALtG Y).Af X3 - f Fjl, Tt '101.OW 55-{k O $37,48
AL CONSTRUCIION AND PLAN
LESS : )1'1
RECEIPT
DATE
BY .
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Ot
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
7
Compressor
Insulation
Q _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior th
(-99-
4Drywall
Drywall - Int. Lath
o - Q $ F
Final
Final
I -1—It-00
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
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
: Q g
Encapsulation
Gas Piping
Gas Test
16 2Z CKE 'S
Appliances
Final
COMMENTS:
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)
01!27/2000 13:59 7609561169 RAINCROSS CONTRACTOR PAGE 02
MWOU U
ROWNG EOMMAMU
Catellus Residential Group
5 Park Plaza Suite 400
Irvine, Ca. 92614
Re: O'Hagen Vent Installation
Lot: 13
Project: Mira Flores Project., La Qunita
OUte ContxaetW $
W"tae No. 631677
To Whom it may concern
The specified amount of O'Hagen vents were installed correctly, per builders
calculations and manufacturers recommendations.
i
Rick Pettit
Raincross Contractors Inc
6185 Magnolia Ave., #534 • Riverside, California 92906 909-423-0334 FAX 90*413-0031