9808-210 (SFD)I
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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
72NI24 13 II%
tD e j 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.
(,() 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.
AMRiCA,'N INS. CO. DWCS076()_300
(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 rovisions.
VDate:,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.
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
i the above-mentioned property for inspection purposes.
Signature (Owner/Agent)= +�'" `- Date�f�''7
BUILDING PERMIT PERM's#ttWzttl CONTROL#
DATE 1 VALUATION .sai,2 � au LOT 35 TRACT 2841.6 9
JOB SITE
ADDRESS 79-"1' C,IDRA
APN 7694(tii-b.15
OWNER
CONTRACTOR / DESIGNER / ENGINEER
:?t: 0 t?P:r't:1USIN G I.1,('
cr Trs'r.r.tt� RI;SiMIT11AT. CONISMUCMON
PARK PLAZA STEE 40
5 PARK PLATA, Sli1TE 4W
IRVINE CA 92614
IRVINE C'A 92014
(71,47'11-61100 C113114 1{)72
USE OF PERMIT
.Wvt..1;ANWA DWEILIN6
Wli) - 3A-62, Li.)Til 35, VER&ti[T CKXiS NOT INCLUt ji BLlilX WALL
C11R P(JUL. PLAN t'ftH_*K FIA-' KFI) K -D 75°: FOR NILILT'[PLE ISSUANCE f -W
SAX41s TPLAN TYPE.
CUSTOM CvtiS RUC -13 N 3,87,9.(1 Sr
l�ltt:l31l�AI'Ic�+ 310.Oti 51.
0ARA0W Ak k1RT 76.3,0o t.F
N ti UNIA11+',U COXF OF CONSTIZUCtION
.321,1451."
PERMIT II&E SUMMARY
CONs'17 U(.110N"Y. 101-000-418-000 SI,416.9r
Pf AN C1iFC'K FFF 101-f.1tN1-119-3!8 V" 107
.%IE*(1W,IICAL 1�i-fi 101-0()0.721-000 $124,00
ELECI1GCAL FEL 101-000-420.OW S?JS.ci3
PLUMARv*0 ff11E 101-1)00 19-{}1H) SZ:"�.25
STltp?fC rtitnTl��N FFF - RFSIn 101-000-241-000 532 13
GRAT)INU FEE tot -o00 -42.44M 520.010
INFRASTRUOTURE Frr: 225-000-443-342 %G,(iK1AA3
ART IN MiLIC PLAC1+5 - RES11: 701-000-255-M $553.1;
51JRTOTA I O N.' rWT(MON AND PI AN OI I CK
;R,uf10 01
L `f. PRE -PAID FIFES
P
ICAO
TOTAL. PERMIT FFI S DIT1Ir N04V
�c,v+Iw.a1
NOV 12 1998
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 2
Underground Ducts
Forms & Footings l _mac _ _
Ducts
Slab Grade
Return Air
_
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
Framing =
F.A.U.
Compressor(
Insulation 3� _ G
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_l
Final
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 �% j G
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
_
Sewer Connection 1 Z �j C�
Encapsulation
Gas Piping
Gas Test _g?
Appliances
Final
COMMENTS:
Final
Utility Notice
(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lour Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
t
Final
Utility Notice (Perm) 6 2
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
ollowing.
BUILDING ADDRESS:
Use Classification: SFD
79-643 CIDRA
Bldg. Permit No.: 9808-210
Occupancy Group: R3 Type of Construction: VN Land Use Zone: LR
Owner of Building: CATELLUS RESIDENTIAL
Building Official
Address:
5 PARK PLAZA SUITE 400
City:.
IRVINE CA 9261
By:
KIRK KIRKLAND
Date: 9-10-99
POST IN A CONSPICUOUS PLACE