0203-372 (SFD)79819 Ambassador Cir
0203-372
t LICENSED CONTRACTOR DECLARATION
IAbereby— irm under penalty of perjury that I am licensed under provisions of
\dtapteX. (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 }3 F , 3 0f31102
Date 6 f•`• 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
( ) 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.
Se1) I have and will maintain workers' compensation insurance, as required by
ction 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 GOLDEN Mou IN& Policy No. WC44406843
(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: `' - j -/l 2 Applicant 44, (
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
afety_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 authorize representatives of this City to enter upon''
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) 'l " * "i' ,fry Date,'?
BUILDING PERMIT PERMIT#
DATE VALUATION LOT' TRACT
.✓ % ' r / 1,CB .ti i5 24 1197-5
JOB SITE
APN
ADDRESS 79-83' AAM&WADOP. MCLE
604-0,72,008
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENTURY CROW 1?KI..L tic" MIAECiiv"MIMS
CENTURY CRrJWs`T.:L (110f41AUN1'irb;ib,
1535 IO. IrD, 9 MI M& ft00
1535 BO, "rr mR11:rr. a1m #10o
:3aXBTA,2N &D..W0 CA 5+1408
SAOMNAMBTO CA 92408
(909)381 -60CY7 MR 2120
USE OF PERMIT
ISTOTali. : PA1\My D'V I LL1140
S:lI'4:) F LOT 16 J?I..AN SX8. PER_.'M1 d J..:114aa Ncyr INCL'4JDZ &DCK
W.AUA € (,)01, S19A CP. DRIV MVA.' :AP Pf30ACtf, '75% PLA 14 C ffZ(-'K ,i+' '
RVEDUC:`f ION FOIZ MUL-TIPLE =UANCE OF SAME FIaAN T'1' PP,
TRACT C 0NOTRUC.`TJON 2,021.00 OF
PORICNI NATIO 11.010 SF
0fiTtAWC',AeRPORT 411410 SF
EgM. 11AIM COI OF C"..ON1si'1I'4lMC' N
11 °
11M1 ITFEL fiiCbApty
CONSTRUCTION 119F, 101,,000-41.8.000 S?04+.0A
PLAN CHECK E: 101-000,143.0-318 $14717
MEC:KAN,1CAL FF -It 101-000.421.000 $60.00
O.d.XCTRIC AL F&F 101-O&D-420-000 S.! 2!. "fit
PLi3MB111410 FEE 101-000419-000 $1410
STRaNO NOTION FE • W1 ID 101-OCiO-241.000 $11.81
CiR AD11 0 "11L 01-000-423-000 SAW
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FINANCEDEPT. h n : i „ ;
I IIIIIII VIII III VIII IIII 16
IE
RECEIPT
DATE
BY
DATE FINALEDv
INSPECTOR
INSPECTION RECORD
Ar OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
at BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
— —
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
— 9 2
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
— Z
Drywall - Int. Lath
Final
/��6 zJ,>f,
Final
POOLS - SPAS
BLOCKWALL
AOPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
— — 7,
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
v
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) ,p
f-1
1
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: 79-819 AMBASSADOR CIRCLE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: CENTURY CROWELL COMM
Building Official
v Ri
Bldg. Permit No.: 0203-372
Land Use Zone: RL
Address: 1535 SO. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-09-2002
POST IN A CONSPICUOUS PLACE