9812-155 (SFD)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
70H3 i 13 B , ✓.41
Date. ignature oflContraofr!:✓�~^�r�G
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.
GYOLDEN EAOLE INS. N%VC, 476055-011
(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 Californiaand agree that if I should become
subject to the workers' compensation provisions of Section 3700,.df the Labor
_
Code, I shall forthwith.comply with those pro isions •'»
Date:12 &'4pplicant+ ,,,'
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 authorizerepresentatives of this City to enter upon
the above-mentioned property for inspection•purposes.'
Signature (Owne%Age tt i/_�l`—ate
BUILDING PERMIT PERMIT# \
.
DATE VALUATION $314,478.20 LOT Fm� TRACT 229838-1
`T
17-12 ^/ A
JOB SITE
ADDRESS 81-080 GOLF VIE DRIVE,
APN
761-500.-002
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RIELLY HOMES, WC.
RIELL Y IHOMES, INC.
23 CORPORATE PLAZA, 9245
23 CORPORATE PLAZA, #2145
NEWPORT BEACH CA 42660
NEWPORT BEACH CA. 42660
{9491'719-4975 CPL# "37
'
USE OF PERMIT
S)'N+;wGE HAM1LY D W 8 L L I N 0
LOT 64, PLAN 6C. SPD - PRclviiT DClr `3 NOT.NCLUDER BLOCK WALLS
OR POOL. PI. AN CHECK F'E1~ REDUCED 754;, FOR. MULTIPLE ISSUkA.NCE OF
SAA E PLAN TYPE.
C:t:TSTOM CO STKUC Vf ON 31698.00 SF
PORCWPATIO 7121.00 Sp
GAIZAWF ARPORT 86A.00 SF
LSTIM. LTE D CO3Mf OC CONSTRUCTION
314,478..20
PER1414'i FEE SUMMARY
CONSMUCT1NN3EE 101-000-418.000 $1,392.00
PLAN CHECK FEE 101.000.439-318 $251.41
MECHANICAL FRES 101-000421-000 $117.50
ELEC7°i1;i.0 AL FIEF, 101 -000-420-000 5201.21
PLUMBING 'FHS 1.01.0004191,000 $199:75
31RONG M0110N ME - RES11) 101 -000 -*1)41-000 $31.45
GRADt'NGaf.:l 10;1-0030-423-000 $20.00
IMFRASTRUC" I'U M Fa," 225-000-443-342 Sb,fl01}.00
AR:.I' LN PUBLIC 1. ACES- RES IC 70.1-000-255-0f10 $530:20
iyk
SUB -TOTAL COr18TRUCTION AND F'LA'N CHECK
S8;782.52
LESS PRE-PNIO FEES
50.00
�y}
TOTAL PERMIT FEES DUE NONV
58,78.2.52
DEC 2 4 1998
RECEIPT FDATE
;,[BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts s
Fors 8 Footings
S'
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
//
Exhaust Fans
0. K. to Wrap
F.A.U.
.Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls v
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/
Drywall - Int. th
X
Final
Final Z
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
94_7
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. 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
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp..Use of Power
Final, .
Utility Notice (Perm)
COMMENTS:
G���'� 1,014
/ 1
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: 81-0.80 GOLF VIEW DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9812-155
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: RIELLY HOMES, INC
Building Official
Address: 23 CORPORATE PLAZA, #245
City: NEWPORT BEACH, CA., 92660
By: DANIEL P. CRAWFORD JR.
Date: 12/14/99
POST IN A CONSPICUOUS PLACE