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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
719113 % V-20 00
Date ,q� % t��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.
GOLry1QEl�NR', NWC 476055-01
(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 provlslons,
Date:
�I��,�y-+Applicant) �.�r�
Warning: Failure to secure Wbrkers' Compensation coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify F
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectionopurposes.
Signature
Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
I'1 .
JOB SITE i L `
ADDRESS 91-015 GOLF VfEW i,I IVA
APN
761-5110-01M
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RIELLY HOMES, .L TC.
RJELLY HOLIES, INTC.
23 CORPORATE PLAZA, 9243
23 CORPORATE PLAZA, 6245
NEWPORT BEACH CA 92660
NEWPORT BEACH rA !'Q660
(!1.jt117�f3 :14 1 t X13.1:.►% 5337
USE OF PERMIT
SINGLE i"AtOILY DWELLING
LOT 39, PLAN 6AR. S'r"O - PPRWIT DOES NUs iWL1Ji F, BLOCK W AUS
OR POOL, PLAN CHECK.FF183 REDUCED 75% FOR NAXT:P.LE ISSUANCE OF
SMVIE PLAN TYPE,.
CUSTO&I CONSTRUCT.1(,3N 3,698,00 SN
t` ORCIVPriTIO 7.1EW Sia`
0ARAcmicA32rou 364.01) SF
C e'g'LNIA'$'.E D COST O1+ i;Z.:161z1'`l`RUCf 101N
314,:478.20
PERWHT VEX,SUMN"Ry
CONSTRUCITON FEE 10.1-000-418-000 $1,392.04
PI,ARf CBECK FFG .101-000430-318 $28.141
MECHA.NICALFt:FE 101-ti0C 421-000 $117.50
ELHC..!`.RJC:AK. FEE 101-000420-000 $204.21
PLUMBING FEE 101-000-419-000 $1.99.75
STRONG kNIOTION M - RE80) 1.01.000.241-000 $31.45
GRADING Mi 101-000-423-000 $20.00
iNFRASTRUC"PUit1%:Fk.l 225-000-443-342 $6,000.00
ART 1N PUBLIC PLACES - RESID 201-000-2.54»000 5336.20
v
` SU13-TOTAL CON91'011CTION AND PL.i 4 CHECK
38,715?.5r
y r LESS PRI,'- lRA1D FVES
U.00
r
u
T0TX€ PERMIT -1(?ca4.Duc Now
58,782.52
-r
~
RECEIPT ' '
DATE
By °+
DATE FINALED
INSPECTOR
iw1, '
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms 8 Footings 4 Ducts
Slab Grade dazaReturn Air
Steel Combustion Air
Roof Deck Exhaust Fans
O.K. to Wrap 30AV F.A.U.
Framing i Compressor
Insulation Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wali Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
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 / / Heater Final
Water Piping Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans O.K. for -Finish Piaster
Sewer Lateral Pool Cover
Sewer Connection J 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)
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 ADDRESS:
81-015 GOLF VIEW DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: RIELLY HOMES, INC.
Building Official
Bldg. Permit No.: 9812-146
VN -Land Use Zone: RL
Address: 23 CORPORATE PLAZA, #245
City: NEWPORT BEACH, CA., 92660
By: DANIEL P. CRAWFORD JR.
Date: 1/11/2000
POST IN A CONSPICUOUS PLACE