9906-248 (SFD)F1
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 ttl91 I3 tic. Class Exp. D(1112�J{i0i
ate-� rSignature of Contractor! / Cs
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
Sects n 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. y� 4`0 .02 iAxu vis. *'r
(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
subj,eet to the workers' compensation, proviislons of Section,3700 of the Labor
Cg6e, I s all f rthwith comply with diose•provisions4' —7 '
, date: GAPPIican?
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 herebyfauthorize r presentatives of this City to enter upon
the/above-mentioned propeertrty•for inspection•purposes%''f
vSignature (Owne/r /�ent �� _--��"pate `� f
"PVW%,
BUILDING, PERMIT PERMIT II .:•"
(f
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DATE VALUATION 'a"Y1" LOT TRACT`4�38-1
JOBSITE1�9X'SS16�-1ii1Z
ADDRESS •-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Kint''Y 1 mws, .1TI;'.
PI1'.Yr1+Y HC3MFS, INCy.
23 C0100kA.'Ti PLYVA„ 492,15
23 CORPORA'I'L" PI:.tiZk -4245
Nl WI'OWP FWACt-1 CA 142660
T3LsW.1'O4i:'I 131,'A.C.1i CA 9260
(449)719-4-975 C:t.# 5-137
USE OF PERMIT
SII\€G LE F AM IY DW.riji<fNG
F.
ZWU - LQ163 VLAN J.tS -.NL. M-141 L)UtIN NIQ1 S.tul l U1Jk4flLUt n WAIL
3UAN02 C'R SAMEKA1> TYP8
i USTOXI `.\7141c"T M-11.1034 3,40!-1.00 S1,
FOt'1C;.f 1 VAT.IO 751.00 SI'
�.D�1ftAd13liJAlt!'t"t!c'I' Sl�.a10:31�
.
t
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I'LRJhlIT FFE S10N4 MARY
OCiNwi 'RU0`C1:gN ,FEE 10 -OW-41 i3 ,WO $1.,31, l . i
r!,A'NCHECK FFT: C1264,58
TC3: XIC. 1. E 3, 101-000-41 $1.1 �sIf:SC
.S IER.YRTC:'Ar F8 C, IN -1300426-000 $1i3,0fi
PLCfAIBING Rh 101. -inti -410-000 $187.75
S',fRQNC1:KQ`1'3QNI:rte_RE19 $2g,15
011A. YNCI,1JrX 10.14=-423-000 $20,Q0
-
tKFRASTRUCf(JAE_E`!?R 225-000-443-342 $6.000.00
.ARC '1N PLt.B1:IC" PLACHfS - .R1:SIC 701-000-25_5-000 $478.76
CTJ l_3'iUDM, C:C1�t� STT( UG -TION ANI P1 AN C'6d'f;0\'
�i�;hfl3:afl
°1'O I!'.A.►:..1'ERNIA!' 3li'EE$1DUE, NOW'
$8,60 10
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
'.'Set Backs A
Underground Ducts
Forms & Footings f,y
Ducts
Slab Grade // /Tj
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation Zb
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail 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
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 da
Pool Cover
Sewer Connection fEncapsulation
Gas Piping
Gas Test i
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 i
Utility Notice (Perm)-
COMMENTS:
NOV-08-2000 15:04 WESTERN INSULATION 909 686 8786 'P. 14i20'
WESTERN INSULATION, INC.
4211 Latham Surat, Riversidc, California 92501
Tal. (909) 686-8760 Fax (909) 686.8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: _ PGA WEST - PHASE 1 B
LOT # : 63
SITE ADDRESS: 81-110 GOLF VIEW DR, WEST COVINA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER:
CEILINGS:
MANUFACTURER:
CEILINGS:
MANUFACTURER:
JOHNS MANVILLE THICKNESS:
ATS
BLOW
JOHNS MANVILLE
THICKNESS:
ATTS
BLOW
JOHN ANVILLE
. THICKNESS:
GENERAL CONTRACTOR: RIELLY HOMES
3 5/8 " R -VALUE: R-13
6 3/4" R -VALUE: R-19
ill, R -VALUE: R-30
BY:
TITLE:
DATE:
INSULATION CONTRACT: WESTERN INSULATION, INC.
LICENSE NUMBER: 491278
BY:
!F��
TITLE: PRODUCTION ANAGER
DATE NOVEMBER 8, 20 _ ._
08%17%2000• 13:07"' 949=852 8732r .9 DA1lEX ROOFING =>INC GE�?a01'
A w.e
WL
ROOFING INC.
August 17, 2000
Mr. Steve Gibson
Rielly Homes
8I-'120 Legeads Way
La Quinta, CA 92253
Re: Legends @ PGA West, La Quinta, California
Dear Steve:
Below is a listing by lot number of O'Hagen vents installed per your roof plan specifications:
If you have any questions; please feel free to contact me at 949-260-7925.
ou, .
P ick y
Vice President, Operations
17192 AAM SMONG AVFMIE
MM, CA 92614
949/260-79W
949/BS2-1•iap rqx
frf:£q:r
48
3RA
25
49
4B
26
50
2RC
23
51
3B
24
52
4RA
26
53
6C
27
58
5RA
26
59
3C
24
60
6RB
27
61
4C
26
62
6RA
27
63
5B
26
70
5A
26
71
4RB
26
72
2A
23
73
5C
26
74
2RB
23
75
3A
25
If you have any questions; please feel free to contact me at 949-260-7925.
ou, .
P ick y
Vice President, Operations
17192 AAM SMONG AVFMIE
MM, CA 92614
949/260-79W
949/BS2-1•iap rqx
Certificate of Occupancy
City of L.a Quinta
Buildinga'nd 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:
Use Classification
Occupancy Group
SINGLE FAMILY DWELLING
81 -1 10 GOLF VIEW DRIVE
RL Type of Construction: VN
Owner of Building: RIELLY HOMES, INC
—1 a wsn #"e4z,07
Building Official
Bldg. Permit No.: 9906-248
Land Use Zone: RL
Address: 23 COPORATE PLAZA, #245
City: NEWPORT BEACH, CA., 92660
By: DANIEL P. CRAWFORD JR.
Date: 7/12/01
POST IN A CONSPICUOUS PLACE