0203-382 (SFD)79730 America Ct
0203-382
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
Date Z/ 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.
r.( 1 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 dfOLI)E v F,AO1 L LNC. Policy No. WC -M4068-03
(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: ; Applicant-
-Warning:
pplicant —Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property forinspectionpurposes.
Signature (Owner/Agent) rig. / /~ Date
BUILDING PERMIT
PERMIT#
DATE VALUATION LOT'-
TRACT
CONSITR aMON IMF
1011 -CM -41$-000
JOB SITEy ,
PIAN CHECK .Fret,
APN
ADDRESS 9— 30 A ENICA COURT
M&CHA:tJ7M.L 3i ';i101-000-421-000
4di72-6W
OWNER
CONTRACTOR / DESIGNER IEN (NEER
101 -000A.20-000
1271.58
PLi Mar.. i43 RFK
4535 so, 11010iJ2. ' '!', 81F., 42100
SM. B MRARDINO CA 92408
SAN' iMA);AP11I€ O CA 972. 08
101.ODO 241-000
(909)381-609,1 CS1. 212-0
}
USE OF PERMIT
101.000.423-1300
MOO
Sn33 - LDT 26 PI AN 5XBREV, PF,J2Mrf DOPE NOT INCLUDE, BLOCK
'i AL1, % P0014 SPA OR DiIVE'W.t>,Y APPROACK WA PLAN CH1X3, FWI .
RFDUC TION 'FOR MULTIPLE ISSUANCE (7'r' 'fAE: PLIW TWE,
"t PAC'£ C'.OINS°$'RUCTION 2021.01) ,S%
PORC HIPATIO 31.00 SF
Cf,A.'Ic1iOMARPOR F' 417100 SF
1_1 j rli U.05 AM -PAID IKRAu
GUYUi-LAaaUINTA
FINANCEOEPT.
MOVIff FEES DUN NOW
I J.910.V,S 0
gg qq
RECEIPT D1- , 0 i` wI BY r . + I DATE,AI /" 0Z/ INSPECTOR
CONSITR aMON IMF
1011 -CM -41$-000
5 OCOO
PIAN CHECK .Fret,
101 -000-439-2118
$147 t
M&CHA:tJ7M.L 3i ';i101-000-421-000
$60.40
ZL3rt:TRICAL ,812
101 -000A.20-000
1271.58
PLi Mar.. i43 RFK
101.000.419-000
$144,40
STR:L N10 :MOTION FB2 - RESID
101.ODO 241-000
$111.81
OR AI." ING Milt
101.000.423-1300
MOO
Y1X,M.d.+".P1 IM130 .CT FEE,
$1,90700
1_1 j rli U.05 AM -PAID IKRAu
GUYUi-LAaaUINTA
FINANCEOEPT.
MOVIff FEES DUN NOW
I J.910.V,S 0
gg qq
RECEIPT D1- , 0 i` wI BY r . + I DATE,AI /" 0Z/ INSPECTOR
r4i
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
O —2
Ducts
Slab Grade
Return Air
Steel
/li -
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
46 — /(—p Z S
Final
Final's
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 G
- ,2 f — j�
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
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) /atJ • a
COMMENTS:
a
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
79-730 AMERICA COURT
Owner of Building: CENTURY CROWELL COMM.
Building Official
vni
Bldg. Permit No.: 0203-382
Land Use Zone: RL
Address: 1535 SO. "D" STREET
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-19-2002
POST IN A CONSPICUOUS PLACE