0007-111 (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
911:3 13 `' 9/2C
"07
,Date _ Signature of Contract
v
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 CdOuDT!°14I FACILE INS. Policy No. ?IWC 476033-02
(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,
1 shall notsemploy any person in any manner so as to become subject to the
worke ''compensation laws of California, -and agree that if I should become
;?d
rs' compensation pvisions of Section 3700 ofetheLabor
e, I ,ha fort/h, 7th comply wwith',those provisions'„//� �✓'
Annlic nt �i�
Warning: Failure to secure orkers' 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 auth"o"rize r presentatives of this City to enter upon
th above-mentioned propertyrforInsoection-pu poses.
nature .(Owner/gent)' Oat o
BUILDING PERMIT PERMIT#
DATE
`0 Jq VALUATION �Ga V78,%1,40 LOT �Isi TRACT 288138_1
JOB SITE
ADDRESS SA j+C �ri►ynr.+;ivA 1
APN
761-1 V-039
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RMLLY HOYviM, WC.
12& my Roma, n4c.
2: CORPORPIS PJB #245
23 CQRP®RA;fT,, P1 A7A #245
N WPORT 11.E CA 926,60
NEWPORT BWK CA 92,660
(949)719-4975 CUL# 5337
USE OF PERMIT
c� Iv#i(iT .}1�.1+AN1.'[..Y 31Y1T 1:1 1+d C
SFT) - LOT 10 PLAN 4A PERMIT DES NOT INCLUDE POOL, OR BLOCK
WALLS, 71% PLAN CHECK i Wr UCTION FOR MULTIPLE ISSUANCE
CUSTOM CONSTRUCTION U22,00 3F
PORCH/PATIO +940.00 S?
UA RACM31CARPORT (SF) 1.%405.60
ESTRAED C09..P 01r CQNSTRUCrI70H
278,901AO
PER.W11►�b�" SUA04ARY
CONSTRUCTION 1 EE 101.000.418.000 $1,266,00
PLAN CHECK WE 101-000.439-318 $237.35
1b WHA91CAL FEE 101.000.421-000 $111;000
ELECTRICAL IEEE 101-000-420.000 $195.90
PU13M8INOAEF; 101-000.! 19-00() $199.79
ST)ZONG MOT1014 FER • I:SII'! 101-•000-2Ai -000 $27.09
ORADINO PEE 101-000-42.4.000 $20.00
Dia'VB1 OPFIR IMPACT FEE $1,907,00
.ART IN PUBIAC PLACES < ME 701-000-255.006 Sig~/,21
K11B I `SAL CONVIRVIII091 t®W AND PIAN MW ,01,
$4.,172.23
IMS PRF, -PAM TM
M00
� ;U .:'MAL
'$4,17223
PY1 _ lYff YEX DUC, NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
3i
Ducts
Stab 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
7A-Tf 7—
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
3t
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
3/
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)
FEB -09-2001 14:35 r WESTERN INSULATION
909 686 8786 P.11i24
= Y�
WES'T'ERN IN'SUL'ATION INC.
4211 Latham Strm, Riverside, California 92501
Tel. (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: # 28838/ PHASE 2
LOT #: 10
SITE ADDRESS: 81-105 LEGENDS WAY, CA
-----------------------------------------------------
_E_XTERIOR WALLS.-
MANUFACTURER:
ALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 3/4 " R -VALUE: R-19
CEILINGS: BA BLOW
MANUFACTURER JOHN MANVILLE THICKNESS 11 " R -VALUE: R-30
GENERAL CONTRACTOR' RIELLY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTIO ANAGER
DATE FEBRUARY 9, 2001
jljr
DAVEY
ROOFING INC.
March 22, 2001
Mr. Steve Gibson
Rielly Homes
81-120 Legends Way
La Quinta, California 92253
Dear Steve:
The following is a listing, by lot number, of the O'Hagin vents installed at Legends at PGA West in La
Quinta, per your roof plan specifications:
LOT NUMBER
ROOF PLAN
NO. OF VENTS
INSTALLED
1
3RC
25
2
3A
25
3
2BR
23
4
4C
26
5
5AR
26
6
3C
24
7
4AR
26
8
6A
27
9
4AR
26
's 10
4A
26
11
6AR
27
12
6B
27
13
2BR
23
14
4A
26
15
6AR
27
16
6B
27
31
4B
26
32
5CR
26
33
6A
27
34
4AR
26
35 1
3B
24
36
4-2A
3CR
24
37
26
If you have any questions, please call me at (949) 260-7925.
n erely
a k a
Vice Pr sident-Operations
17182 AR 1RONG AVENUE
IRVINE, CA 92614
9491260-7900 .
9491852-1160 FAX
www.doveyroofirxj.com
,I
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: RIELLY HOMES, INC
Building -Official
81-105 LEGENDS
vti
Bldg. Permit No.: 0007-111
Land Use Zone: 4L
Address: 23 CORPORATE PLAZA, #245
City: NEWPORT BEACH, CA., 92260..
By: DANIEL P. CRAWFORD JR.
Date: 4/25/01
POST IN A CONSPICUOUS PLACE