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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
7191.13 B �} 2729100
Date1/0t/�� Signature of Contractor- --%=off'"— ✓-/�'- --�
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.
GOLOE14 EAGLE tNS. NWS; 436045.01
(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+Woikers' Compensation coverage is unlawful and
d~
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and SafetyA,
for a permit subject to the conditions and restrictions set forth on his"
application.' S '
1. Each person upon whose behalf this application is made & each person at , r
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify "
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building,
construction, and hereby authorize representatives of this City to enter upon it
the above-mentioned property for ins�pe�ction Purposes.,
Signature (Ownefr/Agent); ��� / »�. Date
BUILDING PERMIT PERMIT -IA
DATE VALUATION$�S1t LOT TRACT
11 ��.298,W-11-�'
JOB SIT 11
ADDRESS 81-060 GOLF V0,'W DRi V 8s
APN
761-5WOO.Z
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RIELLY HOMES, INC.
RtELLY.HOMES, INC;.
23 CORPORATE PLAZA, #245
23 CORPORKrE PLAZA, #24;
NEWPORTBEACH CA 92660
NEWPORT 8Li NCH CA 92660
(949)71.9-4,975 CBL# 5337
USE OF PERMIT
�1
SiAb(tLE FA.�i1L5` ia1 1 1,LINCi
LOT 63. PLAN 5AR.. 5-1 •• PR"R&fJT t0G:ES NOT D4CLUDE EL(X:K WtNus
OR :POOL. PLAN CRFC'K. FEE REDUCED 7Wo FOR NUILTIPLE ISSUANCE OF
SAME PLAN TYPE.
CUSTOM CONSTRUCTION 3,403.00 SF
PORCH/PATIO 754.00 SF
C. rARAG.E/CARPORT 812.00 SF
CIffl1VI:ATED COSiOF CONSTRUCTION
29.1,504.50
'PERMIT FEE SUMMARY
C'O1VSTRUCTION FEE; 101-000-1118-000 S1,30.30
PLAN CHECK FFX 101-000-439=318 $2155.58
11r1ECHAMCAL 06-E 1.0.1-000-421:-1300 $11.7.50
.EL.iEGrRJCAL'FE8 1014)00-4'20-000 $193.06
PLU N1BINO FEF 101-000-4.19`000 $187,75
S`tRONt} NRY110N F'E1r -RE SID 101-000-44,1-000 $29.15
GRADING FFE 1111-000-423-000 32OXA)
11 dFRA.ST.RUCTURE 17.E 225-0011.443-:142 $6,000.00
ART IN PUBLIC PLACES • RFSIt "101-000-255-000 $478.76
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.SUB 1U TAL CONS 1'RUC"[2ON AMU PLAN CHECK
S8r 603.30
LESS PIZB-P.t•11O 1711 ES
$0.t1L'
DEC 2 4 1998
TOTAL P.ERi11'1ff FEES DUE, NOW
'18,603.30
RECEIPT
DATE
BY/ _
DATE FINALED
INSPECTOR
r
i+
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
f
Compressor
Insulation
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 APPROV LS
POOLS - SPAS
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 LinesIVIS
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure .
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover -
Sewer Connection
Q
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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 44 4144
Utility Notice (Perm)
COMMENTS:
z
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:. 81-060 GOLF VIEW DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9812-156
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: . RL
Owner of Building: RIELLY HOMES, INC Address: 23 CORPORATE PLAZA, #245
City: NEWPORT BEACH, CA., 92660
By: DANIEL P. CRAWFORD JR.
Date: 1/12/2000
Building Official
POST IN A CONSPICUOUS PLACE