9905-241 (SFD)LICENSED CONTRACTOR DECLARATION
,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
6372-52 a (IV29n0i
ate 6 .g 22 Signature of Contractor _A0 AV
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 he 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.
()cp 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 INS. CO, Or, 4,59Wt
(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 fo ith comply with thos-d provis ons. t
., ate: 40' Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at y
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees. '
2. Any permit issued as a result of this application becomes null and void if ;.
work is not commenced within 180 days from date of issuance of such a
permit, or cessation of work for 180 days will subject permit to cancellation
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fo inspection purposes. i
\./Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT 91A05-241,
1
.
DATE VALUATION S103.248.90 LOT 39 TRACTJOB
ADDRESS 47-� 75 !J¢ar i TL.�.1.� MRI S ��IdtS.ES E
APN
OWNERy
CONTRACTOR /DESIGNER /ENGINEER
j>.v ��if{A+s,
-
jY�Nl.>/Oija( , RE
Y,'ots/r uc ot
1"x.(iXET./j s k"E.'si DE ll
3 PARK PLAZA. SUT rW 4100
5 PARD PLAZA, SUnT 40
CA 9761.4
itZ.t'N.1; CA. 42614
(949)251-61100 E: ffl,40 4077
USE OF PERMIT
SA) - 'PLAN .4AE , LOT 9 - ,1a t1OT POES NOT INCILUVERLOCK WALLS
4aiL POOL. 0-4,101 U-111�:.1>..VOWI,'ia N IbF t=M;:Li.E%10ICFD 75%, F R MiIL'T•1,,! Lf6
fwS$IR.RtsILO SAW!F-Pt:AN TYPE
Tk lily T ClYTQS INZUC`1`lON I.W3.00 5F
PORCI•I7AA110 1:1(.0(1 S4+°
QA tA.0 JC1U01 R`.1 l.ffU Sl
A,• f�3T.Ai0:fN1,ED CMTOF 'CO aSTIAUC•4ON
.1M.Ik,248.90
PE'RIKIT PC, E SUMMARY
C,0NWr.teUC11110N Ff E 101-000-4184M $671,W
(aF.R\,Nr H -K. FEE, $40.50
trXil�C"wC.`m, E M. $66.5
E)XiL'" LIUe AL C FX 1.01-000-420Y000 $120.43
PLQM-81NOFEi? 101-000-419-000 $142.00
s1,V__0!4Qlv*TIONM? �-RJESM 101-10M-1741-000 $10,32
C 9433 PEF, 101-000423-000
tt�t.FRA,,n,REJr✓" rwfRLF1w 22-5.000-443-342 $2.:397.30
.AXr ilv 1?u.BI.IC PLAC1% - RESIC 701 -OW -255 -WO ti`o.rx
-SUR-TCAA1, C -,"_1QN INNIn :Pf Nf''TIFt-'K
$3'n,t7
ESS PRE-PAIDPETS
$0.00
16p Ill.,
�
9: p" 81999 TOTAL :PERM � �`EVO OUE OUr
���,���.�. r
Jud
RECEIPT
DATE
•
By �f /
DATE FINALED
INSPECTOR
IM
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
/„ / p a
�`f
Underground Ducts
Ducts
Stab Grade
Return Air
Steel
Combustion Air
Roof Deck
Q J
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
o .jp _S"r
Compressor
Insulation
_ Q gZZ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
S %
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.IC 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
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final t_ -z (,-i I—
Utilityy Notice (Perm)
COMMENTS:
01/27/2000 13:59 7609561168 RAINCROSS CONTRACTOR PAGE 08
.r r U00A00 No. 63S67 '7
RD
Catellus Residential Group
5 ]Park Plaza Suite 400
Irvine, Ca. 92614 _
Re: O'Hagen► Vent Installation ' t
Lot: 32
Project: Mira Flores Project, La Qunita
j
To Whom it may croncern: y
y
The specified amount of O'Hagen vents were installed correctly, per builders
calculations and manufacturers recommendations.
Rick Pettit
'n Toss Contractors Inc.
r
FAX �98o9-4x3-"5,16183 10 agn*Ua Ave.. #354 • iRiveraide� CaUtornia 925069N 4s3-0334 �