9812-138 (SFD)_LICENSED CONTRACTOR DECLARATION
�P 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 arid
ir'Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
010wo-
Date `y'' �aS gnature of Contrracto
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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). '
O 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.
(This section need not be c mpleted if the permit valuation is or $00.0� or ess).
( ) 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; anYd 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 provlslons:�y��,
Date��Applicant�T _`�
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 forthi,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 e
& hold harmless the City of La Quinta, its officers, agents and employees. t
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 entetrsupon
the above-mentioned property for, purposes./'
Si nature (Owner/A ent)�✓✓/ r �� rte"' �- =Date
BUILDING PERMIT PERMITk
DATE VALUATION LOT 4)812,138 1 TRACT
�U'gsj C1 dl 29 ►�K' ? iR_7
JOB SITE
APN
ADDRESS
OWNER CONTRACTOR/DESIGNER/ENGINEER
1-3.1FLLY i'It:a1L'Ii.ES, INC, PUML4" i- OME% INC.
23 COR1'raP1TE PLAZA, #2.15 13 CORPORATE PLAZA, P245
NEWPORT BEACHCA 92MO NENVPORT BEACH CA. 92660
(949)719-4975 CBLY 5337
USE OF PERMIT '
LOT 25%. PLAN 6_A- ;i1�`D PERMIT DOES NOT 1NCL1iYU- "7eL Oc;K. WAVALS '
OR POOL.
cus,'om i:ONSTRU/:;""C ON' 3,698,00 SF
P0kCFPATI0 71100 Sp
GARAMICARPO f° 864.00 SI+
ESTIMATED COST €9:a, CONSTRUCfi01N
M4,4718.211
k'ERMIT"FEE Stli!V1MA•>FRY
CONSTRUCTION ME101-000-418-000 $1,392.00
PLAN CHECK FEE 101-000••439-31$ $1,1.21.65
I\/ECRANICAL FIE 101-000-421-000 $117,50
E1.t;C"'i'1 XAL fa1»}: 101-000-420-000 S-24.21
P.1.i.U'A-1}'31NC F'F1< 1014X)0-4194= $199.75
S:1'RON0 MOTION - RE51n 101-OW24.1-000 $31.45
GRAD114G FM 101-000-423-000 $20.00
iMl'RAr" TR11JC 11 fRE HSI>1 "225-000-443-342 $6,0(josili
.MtT IN l?1.43LIC PLACF,s .RESIC 701-000-25.5.000 s5�.zo
I SUB!"rC?'LAL CONSTRUCTION AND PLAN CHECK
LESS PRE -PAM) FUS
S'0,00
DEC 2 ��Jg�
Taw, P'ERNITT FEES DUE'NOMT
S9,624.76
>
RECEIPT
DATE
BY J G
DATE FINALED
INSPECTOR
t`
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade ,s L
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing /S
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 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 TestFEE
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
i
Certificate of Occup,ancy
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:
81-180 LEGENDS WAY
Owner of Building: RIELLY HOMES, INC.
-7-,1,/4-
Building Official
Bldg. Permit No.: 9812-138
Land Use Zone: RL
Address: RIELLY HOMES, INC.
City: 23 CORPORATE PLAZA, #245
By: GARY HARTMAN
Date: 10/29/01
POST IN A CONSPICUOUS PLACE