9905-237 (SFD)U)
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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
637232 B 02/'29J,20i
Date ' 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).
( ),p.l, 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.
M 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
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
3Z(3 eil WS. CO., OF i P'i C 45)2 r'
(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 pr visions of Section 3700 of the Labor
Code, I shall forthwith comply with tho ovlsi
ate: _ �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. -Y;
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.
,SIgnature (Owner/Agent) ` _ Date r�
a, a
BUILDING PERMIT PERMIT "W's-237
DATE{ VALUATION S.t..14,993.(31) LOT 11i TRACT 28601-1
JOB 9rfE
ADDRESS /9-553 CA&SIA -ST RfX
APN 6j��/•-d 305 0x0
OWNER
CONTRACTOR/ DESIGNER ENGINEER
C*.1kTFi.",J,r RESIDENIrIAT. AIRJPryMS,
{ES, DENIM[, Cy6RI
5 PARK PLAZA, SU T4 400
.+ PARK PSA, SUi TE 400
IRV01 CA 9261.4
IRVINE (,'A 42614
i94Ji'3S1 (+11}(3 C:f3i,# 5072
USE OF PERMIT
SINGLE 3~ t1+313:]`'.i: WE;l.E;1NG
SFll - PLAN 2A, LOT16, - PW'RhUT DOES NOT iNCLUDE .ULOt" iti WALLS
09.1100L..VLAN 1 6";�` '1+(ePl"1'.tea'[v' iia t^ksE `=i:E1: U k-0 75"rofOR 11-1t)1,TI,N.L
ISSUANCE OF SAM(t, P:LAN't'WIL
MACi' CONSTP.UC1'ICIN 3,914.00 a1•1
PORCW!`M110 120.00 SF
(JARA.IDWCARPOkt`r 483.W St'
MIll7. IIF VEE SMI MIXIty
CON S*I'RU(-" LON Fly 101-000 418 -OW S692.01)
MAN (;f1F0.1 R41. JW -0(10.439-319 V45 -M
N'11.7 f1AXICAL I r 3, 1011 -OW -421-000 $()& 010
ELEC'MWAL Fs €3 $f. r.la
I-ktAiMBIhiO FLE $154,00
SIUR(INQ M1:1Ttold (+3'l: - R 4i1;1 f P -000 -MAX) X) .$I1 ,5o
AMNC 113ri 10t-000.423-0013 320,00
•f'Zvi"RAS1 S�tt.Ik"'hfRC- FL -U 225.OW-443.342 $:f,SS I.43
ART 1N l�r<.:IBLIC.' PLACES -12k:`11.1; 701 0(0,255-000 $37.48
1{ �TR P.1,AN G}t1s%1,iYs13.
��
LESS PRX.-NMI) FEES
$0.00
8199�aa
Jud p A i PERK071 VC(DEN D13:NOW
S3r8133.:16
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RECEIPT
DATE
BY Ft
DATE FINALED
INSPECTOR
I mi
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Slab Grade
_
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
$
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
1>T
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
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
$
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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) !'L
COMMENTS:
01/27/2000 13:59 . 7609561168 RAINCROSS CONTRACTOR PACE 05
LR0M5
ROOFING CONMOM
Catellus Residential Group
S Park Plaza Suite 400
Irvine, Ca. 92614
Re: O'Hagen Vent Installation
Lot: 16
Project: Mira Flores Project, La Qu lits
To Whom it may concern:
eta Coatraetor's
Ltoo:lse No. 6;1677
The specified amount of O'Hagen vents were installed correctly, per builders
calculations and manufacturers recommendations.
Rick Pettit
Raincross Contrac ors Inc.
i
i
6165 Magnolia Ave., #354 • Riverside, CaUfornia 92506 909.423-0334 FAX 9d9.4s3,0841