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9905-236 (SFD)U) F - _N U) W O =) M t— C Y V 7 W � o Z r 0. O JVcr) W W F- a N Z M LO N ON U °) CL Z Lo a 0 tL X W — 0_JQ mQU b cl: U-)� Z_ co 5 Q J 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 Date �� I�9 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. S�( )`' I have and will maintain workers' compensation insurance, as required by ion 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. ROYAL A'Nf4CO. OV i PTC 45Y287 (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 p;Pvisions of Section 3700 of the Labor Code, I shall forthwith comply with thoSP91 1'0 pns ' I Date: ` ' `� Applicant- Warning: pplicant 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 i 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 fo" inspection purposes: t I� ,.Signature (Owner/Agent) �� Date BUILDING PERMIT PERMI,0#,I)IM2.56 DATE a J VALUATION YSA108,248egfo LOT TRACTJOB SITE ME � ADDRESS 79-8 7 4.:r'LS5ffik STET APN OWNER CONTRACTO�R� / DESIGNER / ENGINEER p �� (� eft. t9 .•.f �i-1 b Pf ir.�'. I,Y �•{.?{.. 1r.. \,l l4P y3.5J ll i't i1 � fit U I v` lyd iN Y.r {.,siJC 4> 1 il.Aif�4. �v�lry{%�♦ S«�A�4� t fi.Ll\i .:A�Y 3 WOK PLAZA, t4, Sal - , 400 J PIAkK PLP A, SUi"F 19-ki IRVINE CA 92614 6'i2.VINE CA 92614 (949gm-t)lm C113110 5072 USE OF PERMIT SINOL;a FAMILY WRUNG. SF Cj • PLAN WR, LO t'i5 . • P1:.ICMYr J:r+,)ES .NO iNCLOX .L11;,OC-K WALLS Oil. YOUL. KLAX 0ifi .;t. N0lt" 101, Cit' .b'4sPs 10.13Ut i!f� .!5":u t i �!C NMI:`i'1PUE 1SWA1.10E OF SAME 14:AN "VIR TRAC"' CON S'i`Fit3t".'i'iON 1,803,00 Sig f"O);tCf 9/1wto 1200 S 0-Akl1f"•MAft1'+;1R11 441.00 S€' USTIMAT:ED COS; OF CONN3TRU-110W Y 103,243.90 1%, RMIT FQ aY $U N1 MARY CE`)?�b"MIJCi'.tl tN :FitX 1111-000-419-000 5671! 0 MAN CHIEC K FEE ! 01-fM-43931 R $111111.: A 1VWIC;.IIANIOL 1�" M 1©1.000-1,12 1 _0010 Sv6.50 ELl; .: �'12►C:AL ME 101 -OW -420-000 $120.43 PI,UN1.13if ((' i FY_.. I01,4M-419.000 5142.00 S•rR,t NKY MOTION FUR - ~fit" SM 131.610(1-241.-t1C1i1 $10.92 GRADR40,11-1 101.600423-000 $20,00 fit•lbN S'i';ROC:Tl.1€ t FLi , 225 ,000-443-342 $2,397.30 ART IN PU0LJC. PLAQXS -.RfSlP T01, -OW -2.5'4-000 a. `;t= ! .. ` T1s i t�!�`1 �C�i1t?AND 1'1.AN:!�iEC:.K. y � LESS PRE-,1IUD FISTS $0.00 99 -.J )�.,µ[, ��fj// 'Y 1 \�.. RECEIPT DATE BY. I DATE FINALED INSPECTOR 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 G Exhaust Fans O.K. to Wrap Framing �� F.A.U. Compressor Insulation $ — —( Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath /O Drywall - Int. Lath 10 — Final Final °z`®O1 ti LT- 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 " f i 5z Encapsulation Gas Piping Gas Test ZO - 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) -Z - 01/27/2000 13:59 7609561168 RAINCROSS CONTRACTOR PAGE 04 R11MG CON'"Ra MM Catellus Residential Group 5 Park Plaza Suite 400 Irvine, Ca.. 92614 Re: O'Hagen Vent Installation Lot: 15 Project: Mira Flores Project, La Qunita outs Contractor's Uoense No. 631677 To Whom it may concern The specified amount of O'Hagen vents were installed correctly, per builders calculations and manufacturers recommendations. j Rick Pettit Raincross Contract rs Inc. 6105 MsgnoUa Ave., #334 0 Mverelde, California 92506 909-463-0334 WAX 904-4$3-"S1 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 79-867 Cassia Street Bldg. Permit No.: 9905-260 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RMH Owner of Building: CATELLUS RES COMM,INC Address: - 5 PARK PLAZA,SUITE 400 Building Official City: Irvine CA 92614 By: K M HIGGINS Date: 2-29-00 POST IN A CONSPICUOUS PLACE