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9905-243 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of CF9apter 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 0,,37252 02129r201i ate 6 ,6 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 aOcertificate 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: Carver+f�s`` �L tt^1,t Policy No. PTC (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 s��,I.I o with' comply with those • vls ons. / VD`ate: A Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a .permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to . . any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void If work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is. correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon . the above-mentioned property f ' spection pu ose p� ,ol gnature (Owner/Agent) Date G/a/� BUILDING PERMIT PERMIT "95-243 DATEIn j7 y �cVALUATION 1i4,�•) a}0 LOT ? TRACT V � �• JOB SITE�J �L: y�Ys Yyy��( q�e�Y, �r ADDRESS 47440 iA.WLX 6rlR8 � M9 5- S,Y 1'O�UET APN 'Q'!49 030 020 �\ s .7t�- (iD OWNER CONTRACTOR / DESIGNER / ENGINEER 0 ASM, f 'Ir Y 1e' 01:G'ft5nnmYri A I f n-,Ahfl �Ar1'7`tEiC /:Jt.�tY.l!�'♦.1l.t81,,SSN TNTC r -p1 lrii t Tic ©T.S-Tr'1iy`{r,J A r cnt.IT1`i)U�1'it iA1 u 9..11. 1.iY4!1.�11,�1,�a. J. i.XOwl l t 51/.. IJ!}I 1., 1. 11 :�tf r.�i:k K PLAZA, 400 _, PAItK.Pi:AZk SU TE 406 CA 921114 iRVIN'S CA 92614 ( �ti12�1-f1t}(i CMA 54l"r2. USE OF PERMIT SINGLE FAMILY DWELLINQ S�eD M PLAN 2MR'LOT-12, - .P'i�',t;�WI VX- a 1410T .tfV1. LUDE; BLOCK WALLS Oft. POOL, PLAN Cfi :CK POPIt"fUm Cify..)±'a.")e)U100i 7$`'r4� YOK id4111.'1''.1:PLE ISSUANCE CW SAME KAN''C P, 1r1U%'QT C014171 TRUCNIGN 1,91430 "M? POY2Ck3,PAT.I0 12O.W . F 1 GAt210 %G;AE.tbt 1Cf 433.00 SF W1. SMA ilXD?..fff 1? CO VS11IIRU 01•9 P.KRWT F_Pi,K SUMMARY C.C�t�3S'!`iti3�� C)t'1Ai 3� �� li)�•4iiY)-�1:2�-iH)A ffi�ra? ttL� P14AN C {- : .. --, Q1-(0-439,:;19 )'019C'l1ANICAI..t l }a 1t .t {)iI(1-:123-i3t�f3 �t►G. L3 f— c-C"i' 1,011d. Ti IQ!- if)0-X120-t)LIQ $125.15 C'LUM'$1NQ FLE 101-000-4194M 3154.00 SIN c�orrs'4 W10T.10, NF EE - [tES.0) 101. -€3M -24t41100 $11.50 t1RA3�ii�ECi TQC 401 X)0,4n000 520.00 N re.r�°f 'ttCic"1'UR bz 225-•000-443-'342 SZ551.43 A_k`r fN PUMAC° PLACES - RESM 701-t`M,255-000 $37.48 J ' 1 53 TAI. CONMIK TION AND MAN C"EC-K'. �3,St►z.�n LESS PRE 7 �k S rO.t�O TOTAL PER141T FEWS DU F, NOW RECEIPT DATE BY i j DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings o Ducts Stab Grade Return Air Steel Combustion Air Roof Deck . / - 5 Exhaust Fans O.K. to Wrap - QQ F.A.U. Framing o -le - Q `j .57 Compressor Insulation -e Q S? Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 10 —,Z -r- RIF5 Drywall - Int. Lath Final Final 1 i - K 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 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 D -/S- Encapsulation Gas Piping Gas Test a -f S - OF 57 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 11.2Zi•`l Utility Notice (Perm) M_ f r • 01/05/1995 06:21 5099236863 ROOFING CO PAGE 01 I:!?1.'ly'+9 I 4; 760i56'j1 F:kIlh_;='1_I':;;;i'tITF't;TGP F'41 IE X35 R0.55 a:ta4� C�tot�sft0� ROMS CUNMAMW UcOnte 794P. 63014: • r r - December 21, 1999 ' Catellus Residential Group 5 Park Plaza Suite 400 u Irvine, Ca. 92614 Re: O'Hagen Ment .installatio11 ' ProjePt: Mira Flores To Wbom it. may concern': The specifled amount otO'Hagen vents were installed correctly, Per builders calcAtions ar)d rhanufachwers rec*rnrhendations. , Rick Pfit Raiabl'dss Coh&ractors Tne, r ' t y Y, , ' , —• ..- ----• __ :..� �. Alt saee.,.em�sY. _ z