0203-367 (SFD)79760 Ambassador Cir
0203-367
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
714188 B 1 W31/02
Date ' .ti 4. - Signature of Contractor
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.
,Q) 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 (y)1,,VXt4 KACjLE rK., Policy No. kTWC t i ftttfS-t13
(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:. /_..} —;i .APPlicant
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 applicator 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 authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
Z_ Z41,97-5
JOB SITE
ADDRESS 79-7160 .o'11dWASSADOR CIRM .
APN
W4,072,0018
OWNER
CONTRACTOR /DESIGNERNIINEER
CMMIIrmy CROWELL COd pMUS
CEMURY C40WELL tOlMV 2,
15133 01 TI * =x9r, MS #200
15 3 5 00, T' `:1 MD'a 93'9, ft!200,
SM RERNATWIN a CA 92408
M-11a SAI INO CA 9-2409
(.90.3)361.6007 CBMI, 2120
USE OF PERMIT
;mmy,14MLYmm'[ w§
SIN) » 1,01' 11 PIAN 5XC,'REV. 3 Ef .11MIT . ' OIr-S NOT MC'1,UD9 BLDC9,
►I.L13, J,001, SPA ()0. IS;RItdZWAY, AnPI C1 , II. 2S4EP9aATi C°kIICC 1'
REDUCTION FOR MULTIPLE ISa13ANCZ OP S"Z PI.JkN TYPY
TRACT C:C7I+i TRUCTION SF
PORC'HIPAT10 11.80 SP'
GA1I.NOEIt",ARPORT 411.001k'
Et rUdA ED C,'OST OF C:OtMUMON
.11610 55.80
PXRWf FRE Rit i+;4MARY
C;OTIS'IRILICTION F1;'.E 101-000-4418•-000 M.00
PLAN CHECK P19F, 101-000-439-318 $147-17
l~ EC IA UCA L. FEE 101.000-421-000 $60,00
EIXCTRIC•ALn?Z '101-alW-420-000 $1V,38
pL6JMBDI01 FjTE 101 -M-419-01000 $ I48.00
ST O140 MOTION FU - RLS6D 101-000-241-000 $11.81
a:I1di' WNG ME 101.000=423.0011 $2.0.04
DEVELOPER IMPACT .P'E2?
M • A y .O .'i
, :[:i"„{6J Jl.M.A., `Y' . .►Y 1rii,,iJ4.•.Lr.I.0- kY /9
bl
OIXI -03T':C ii •.i l. T€ 1 .'rC °
$0100
. _ AL P > ate' 1=504 nIUE NOW
MAY U 1 2001
CITYOFLAQUIIITA I IIIIIII
VIII III VIII IIII 71
FINANCEDEPT. j
IE
RECEIPT
DATE,,
J
BY”
DATE FINALED
INSPECTOR
I."
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
S
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
.Z
Combustion Air
Roof Deck
- 3Zi - p
Exhaust Fans
O.K. to Wrap
10-�?n --v2
F.A.U.
Framing
Compressor
Insulation
C' — - OZ
Vents
Fireplace P. L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-dam
Final d
BLOCKWALL APWROVALS
Final
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
3 -/ -
Heater Final
Water Piping
_�j _
Plumbing Final
Plumbing Top Out
/
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
I/ - < of S
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) •8
COMMENTS:
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 Const
79-760 AMBASSADOR CIRCLE
Bldg. Permit No.: 0203-367
ruction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 SO. "D" STREET.#200
Building Official
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-09-2002
POST IN A CONSPICUOUS PLACE