9905-235 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
f— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 U)W
Professionals Code, and my License is in full force and effect.
p =) chLicense # Lic. Class Exp. Date
r- O LO 6317257 B 02i2N201
r,L L�1 6
oZ r� VII %n ` 9.99 Signature of Contractor ;
(�D 0
J U (p OWNER -BUILDER DECLARATION
HLUa rl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 1, 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).
C•r) () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
O N
ZWORKER'S COMPENSATION DECLARATION
� Q Z I hereby affirm under penalty of perjury one of the following declarations:
r H O () 1 have and will maintain a certificate of consent to self -insure for workers'
XLUcompensation, as provided for by Section 3700 of the Labor Code, for the
m0 J Q performance of the work for which this permit is issued.
Q () N I have and will maintain workers' compensation insurance, as required by
O CJ Q Section 3700 of the Labor Code, for the performance of the work for which this
I— permit is issued. My workers' compensation insurance carrier & policy no. are:
d Z Carrierp� O �� Policy No.
ago Z) 1.10' AL IfINS, CO. r iY17C 4,59287
0
J (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 ovls' ns. /J % /
ate: Le� Applicant yrf -c�—�yy/s'/
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 A4
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.
S
VSlgnature (Owner/Agent) / Date
#
BUILDING PERMIT PERMIT9905-235.
DATE VALUATION $108,248,90 LOT Q TRACT 29601-1
JOB SITE
ADDRESS i 19-8:1 1 CASSIA W RECT
APN "9-036=020
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C;! 1'1311C1S E'1Li NIL C iv.lVtt 1x11'171 Sj
11,10 CATFs1.T,ii,S RESIDEN IIA.1,, C( N'.1ZI C )Cf ION
5 PARK PLUA, SUT1'I, 400
5 :PARI;. PLt1M, S,'Ul'1Y1• 400
MV1NE' CA 92614
IEtVTNE, CA 97614
(449)251-11.00 CBL# 5072
USE OF PERMIT
SW U, Pc'iiti*LY DWI31 LING -i
RFD - PLAN M. LOT 14, - P1~;RMi'TDOES NO'T INCL 1iTi.S ULOCK
WALL' Olt I~'f:?OL,
TRACT CON 51., C717OsJ 1,80:3m SF
POIZICIMPIAVO iZ8,00 S F'
QA3.CsW1iC:/f::.E k1110R1 441.Q().`.1F
ESTINIX ED COSTO CONSTRUCTION
1113,243.90
�{.,'� $'�(f �j
3-�•�y�a �j'(( FEE
CON:.CP,4 tt, i 1.f:)N FEE 101-000-418-000 nG7 AXIL
pf,AN 101 -090.4V -31R $562,M)
till_000-411.000 S66,50
fyT IX,'. UC XL i7f i. 101-000-420-000 $120.43
PLUNIBCN(; i:.ER 101-000-4194)00 SW2tO
ti'}'i2,C5PiO i4 OTt'OM F):m - RI"+,80 101-(18!1-?414ow-) 9i10 87
GRA.1► M113F 101-000.423-000 $2001
i1VF3ttlT;'. R WTME FEE' 22.5400-44-3-312. $2.397.30
ART M PUBLIC f1f,A-Ey - RY�R. a 701-060 255-000
CONTS"TRUIC`InOW AND PLAN Cf1FOK
$4,010.67
LU"? PRE -PAID FEES
v ,
$0.00
u
ECEIPT�� b
DATE
BY y
DATE FINALED
INSPECTOR
r
.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
t U fCompressor
Insulation
- V.f - Q g
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
O 11
Drywall - Int. Lath
Final
Final
- —Do «
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
4
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
5?
Encapsulation
Gas Piping
Gas Test
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 7609561168 RAINCROSS CONTRACTOR PAGE 0:3
Catellus Residential Group
5 Park Plaza Suite 400
Irvine, Ca. 92614
06to Contrarter's
Lease No. 631677
Re: O'Hagen Vent Installation
Lot: 14
Project: Mira Flores Project, La Qunita
To Whom it may concern
T lie specified amount of O'Hagen vents were installed correctly, per builders
calculations and manufacturers recommendations.
Rick Pettit
Raincross Contractors Inc.
61ST, Magnolia Ave., 0334 9 Riverside, California 92s*b 909^42."334 FAX 909.423 -ossa