9812-148 (SFD)H
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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
'11y11 i 1129100
Date4" ��,,��Signature of Contr- tor• r
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.
C C%,;lXN EAGLEINS, NWC 4M55-01
(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 provisions.
Date: (&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 t k
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 for inspection purposes?y
Signature (Owner Ag�),1C. f � � Date �
BUILDING PERMIT PERMIT#
9 2-I�dS�
DATE VALUATION S27S,901,40 LOT a I TRACT '2XK'W_ I
i'1 el I. . CtV
JOB SITE r n
ADDRESS 8.1-04s00;.006 VI1 V' illi i
APN
761-5414i`;.006
OWNER
CONTRACTOR/DESIGNER/ENGINEER
R113,11Y HONtES, INC.
RIELLY ROWS, INC.
23 CORPORATE PLAZA, 9245
23 CORPORATE PL.. Z,4, 42415
NEWPORT BEACH CA 92060
NEWPORT BEACH CA 92660
i949919-44975 CBL,'## 5337
USE OF PERMIT
SINGLE FAMI-LY iJtU.hLL1NCG
L0741, PLik 4AR. SFD - PER1vi1T DOES NOi` iNCILIDE BLOCK WALLS
OR. .POOL—PLAN C14EC K FEE RMUCE13 75% FOR AM.+TIPLE ISSUANCE OF
SAME PLAN TYPE.
t,`umim CONS9'12u PTOtd 3,222.00 SF
POR.CIWAT10 940.00 Ss:
OAR.kGFXARP0X,r 7136 M SF
ESTIMATED COST OF CONIS•.t UCfION
278i,9U 1.40
'PERMIT FEE SUMMARY
CONSTRUC710N FEE I01-0004.18,000 $1,266.0.0
PLA14 CHECK F& 101-000-4*31 t# 5257335
>♦rtl;r..'1#ANIC,;AL FEE 101-000-421-000 5111.Ct0
ELECTRICAL FE8 101-000-420-000 $1135,99
IJ1LLTX1fR.TNG 1-1E 101-000-44 n•-000 $199.75
ST f ONO IUOT1ON r.ffi - RES10 101-000-241-000 $27.89
C.R,W NO FEE 10.1-000423-000 S20-00
iNF1ZA3TR.II1CTUREFEE 25-000.443.342 $5,9939*
AItT :1N ,P1JBL.IC'PI...ACF!9 -'R ` ' IC '701-000-2y5-000 $447.2.54
j f
` tTl3.1t�1�EL CON;;i`itifC'1'10N AND PLAN C.HECti
x
f I' .S5 PPUIT PAID 1�1TIES
$0.30,
DEC 21 1 TOTAI,. i'1! RM.1 TFEES DUE NOW
RECEIPT w
DATE
BYo-.:
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing ZS
Compressor
Insulation s
Vents
Fireplace P.L.
Grills" '.
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final i XPOOLS
- SPAS
BLOCKWALL APPROV LS
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 Plaster
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 Qu-inta
Building'a.nd.Safety Department
This Certificate issued pursuant to the requirements of Section 709, 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: 81-045 GOLF VIEW DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Parrnit No., 9812.148
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
:t -
Owner of Building: RIELLY HOMES, INC Address: 23 CORPORATE PLAZA, #245
City: NEWPORT BEACH, CA., 92260
By: DANIEL P. CRAWFORD JR.
Date: 11/18/99
Building Official ,;
POST IN A CONSPICUOUS PLACE
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