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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
6 x'.257 B, 02 9120(
A -d
V6/ale � e ' L?� � Signature of Contractor 't%�'"�
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.
`w 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.
ROYAL )NS. CO. OF f k` l"c459237
(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 sh II f rthwith comply with the I roy sio s.
ate: G 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
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. r
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
/thabove-mentioned property for inspection,purposes.
gnature (Owner/Agent) ` ,+ Date
PERMIT #
BUILDING PERMIT
990-739
DATE/_ VALUATION����t��{ �i LOT TRACT ZRv0.3-I .
f /
`".J ' �JOB
SITE
1-5, i
ADDRESS 79.9&SIA o�� RKVIT
APN
649-030-020
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CA7ELLUSR'1,81Dr,NT1AL CONIN'(i I IES,
SNC CE1't,`F. IA.—US RE.SIT)DI'171t1 L CC7m.vROC1,10N
5 PARK PL.A t\, SUIT 400
5 PARK 1'.t.AZ.A, SUM 400
IRVINE, C..t+1, 926 14
IRVINE CA. 926.14
(90)225146100 C.(?IL# 5012
USE OF PERMIT
SIO{r�- fVlY DWEg77
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&M - PLAAi.2& L Yr 18, - PERMIT DOES NST ,INC L.i.il'iE.BLOCK
YAI.I.a Uft t''��C�L.. ;I'# f13d CDik'sC;`.h: istDlZ`I:'it�fyl C�k" I .I i:; (t0�l+rJCED7531,.Fc,.R
M1i.LT1PLX, I.S5UA1NC K OF SAME MAN TYPE
TRACT CONSTRUC1110N 1,9114.00 SF
T'CakiG'I.Iff'A:n6 1:x,0.00 $11
GARAOUCARk'E:1: .1' 483.00 S#.'
��''�'I'�;►Z��'�"I;BD C�S'�' C�;� C:Ci;d?��>r31C'.i(�s;Alei
Id;�aJ,€Id3
Cr,0N81RW7T10,lN IM, 101-000-418-000
$145.30
XTECHANICAL f iE IOI-00t} 42I-OQO S66.50
LiL,I C'TRICA3, FEE 101:000-420-000 $1`2~+,I5
k'I,IJIWBl[N0:F;t:T 101-000-419-000 $154.00
;�'r�t(�Nr} I�rc>n�i 3NT 3. -Rt :1Tn l01•Of -2414)0 53I..50
1.0'{p1�-[000. 2q3-+I�Yq?) ^ant.au
7�1,RAy�z�IPrG..Fr%�{7�{ �n
IAfrl'�A IREfC"i'tJIZU� 26-000-443-342 $2,551.43
AWY I.N4JBLJ..0 PLACES -.1t M-3 1: �U1.0W.2-5-"Wo $37.4$
tt.`I!��'i.'CYYA1.,fi0.t4,'5I It�(;�Q h'hNDPIANC:'KCyk
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T,_SS I`It�-PA rIE_'
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MID
$.3.803.36
JUS p 8199
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RECEIPT
AP UUIt
BY; { ,I(l
DATE FINALED
INSPECTOR
✓.
lr,i�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING Af PROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 411 aitl
Ducts
Slab. Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
57
F.A.U.
_
Framingr
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall -
Exterior Lath o —l! — Z
Drywall - Int. Lath ®- _111
Final
Final Z- -®p
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines • dry
Heater Final
Water Piping I cam/
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 2 —1?—
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) T-2779
01/27!2000 13:59 7609561168
R"CRD-U
ROOM COMMEMU
Catellus Residential Group
5 Park Plaza Suite 400
ovine, Ca. 92614
Re: O'Hagen Vent Installation
Lot: 18
Project: Mira Flores Project, La Qunita
RAINCROSS CONTRACTOR
PAGE 07
i
ate Coatrootos's
I come No. 63167'1
i
To Whom it may concern : '
The specified amount of O'Hagen vents were installed correctly, per builders
calculations and manufacturers recommendations.
Rick Pettit
Raincross Contractors Inc.
6165 Magnolia Ave., x334 • AivorsiAe, California 92506 909-463.0334 FAX 949-423-0051