9812-143 (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
• i Iy1 i.3 13 ,,... 2f",4JiCN;
Datignature of Contractor'-
OWNER-BUILDER
ontractor'-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.
GOLDEN EAGLE INS. Nr%'C 4760155-z)1
(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: 3 Applicant I X�
Warni gailure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to c Iminal 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 apermit 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 `bf 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.
a s,,..
Signature (Owner/Aent) —" �"f - Date / r
.�tk, i't✓' fes, /
All
BUILDING PERMIT PERMIT#
DATE VALUATION 1%225,746.1, 0
%225,746 .J10 LOT TRACT 2181014-1
JOB SITEC
ADDRESS 81-100 EGE040S'WAY J7
.L
APN
7S.Iti1�iiO-(!1'}5
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RIELL Y HOMES, INC.
RiELL ' HOMES, INC..
23 C.O..RPO:RATE PLAZA, #245
23 CORPGR.ATE PL.AZk P245
NEWPORT BENCH CIA 920,60
NEWPORT BEACH C.A. 92660
(919)719-,1975 CBI Pr 5337
USE OF PERMIT
SINGLE 6�Mfl,Y Oti%PLL NG
1.
LOT 31), PI.Ag .2AR, SM - k'F IMIT DOFi NOT 1NANCfXDF RLOC-K AL -LS
OR, POOL.
�USTGiM CONSTRUCTION Z483.00 SF
PORCH/PA`.t IO 1,3444)0 SI'
GARACaLilC ARPURT M.00 .SF
I S'1 IAIAT'3+ D COST OF CONST RUCTION
2$5, ; 46.110
PE—ItMIT EEE SC+A AIA Y
CONSTRUCTION FER 101A0041.8-000 $13080,50
€?T AN CHECK FEE 10.1-000-439-315 58.86.85
evffi, '14ANICAL:FE 101-000421-000 $117.50
1%t:..f CTi`kICAL I 101-.000-120-400 $159..15
PLUND31 NO FEE 101=000-419-000
s tt ONv. OTION FEE- 4CY-SiD 101-000-241-000
GRADING NFA ": 101-000-423-000
.SNF#d, -3,1'Rl.iC' U"_,.:v8p 225-000-,_141 344. 5079:10
t 1"c'[ ,rN PUBLIC PLACES - RR' 701.-000-255.000 $31.1.37
VS'tJtiI"1'G'Frj7. G%ISE1iI.TC`ic7N AND PLM CHECK0,4513.51
s LESS PRE,.VA f0 i<'D,5
`�()•t1t)
YbtC `
-
TOTAL PERMIT Fr,, F-'% DUE NOW
S7,458.54
u
RECEIPT
DATE
BY1� '
DATE FINALED
INSPECTOR
INSPECTION RECORD
.OPERATION
. DATE
INSPECTOR
OPERATION
DATE 7
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
' Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
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
O
Fina(
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
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
, re
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: 81-100 LEGENDS WAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9812-143
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL'
Building Official
Address: RIELLY HOMES, INC.
City: 23 CORPORATE PLAZA, #245
By: GARY HARTMAN
Date: 10/29/01
POST IN A CONSPICUOUS PLACE