0203-383 (SFD)79735 America Ct
0203-383
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 ` '` ` 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 employges 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:
Cartier 00E,1:►l1A4 MOT INS,Policy No. NWC-344964-0
(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 provislons: ,
r
DateZ `3' •- Applicant Z r) v
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 hisx,
application. s:
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) ° ' `*^' rr'r `" Date''
BUILDING PERMIT PERMIT#
DATE r. VALUATION LOT ` TRACT
Maps 21 241 W
JOB SITE APN
ADDRESS 79-13S A IMYCA CQUIRT 6W -0724W
OWNER
C: IURY CRC7WELL COMMMIrrTES
11,535 so'. I'D" s' 'd' rrl UM r` oo
SAN BFURN RDWO CCS. 92409
USE OF PERMIT
CONTRACTOR/DESIGNER/ENGINEER
CFSrMy MOW. -EL
1v5 ;ti,T5 30, "D . O aii`RIWI r, 117M jlftr7
w J.•a7Pl .1.7dsCQ."'9a'•7,ti!::LJ lV 4i'l i "...' GP 7C7: ' '.r
SF31- LO'T 27 P1.AN 5Jit"R. X, PERMIT DOES NOT 114C.F.•LIDE• BLOCK
K
WALLA P0014 SPA OR DRIVEWAY APP3;COACK W f=lata N C3FWKfti:
REDUCT1014 FOR• MUt TlPLE ISStJANCZ OF SAME PI.A14 TYPE
TRACT Gt;?NSTIt1XTION 3;021.00 81?
PORCWPATIO 31.00 SM
GARACEICARPOWr 41100 UP
<.
1 "Ii1Va.Ir.33' Con OY, C:C►manXanoiq 9.60
P 1r'itiilAC:I"1 YEE SUMMARY
CONSTRUCTION! PES 101.000.4.18000 16100
P I;,AN CHECK, FEE 101-000•439-318 $147.17
IuiFi`HMICA M '401.000.421.000 $64.00
E':t EC RIVAL ISE 101-000-420-000 51 r
PLUMk 140 VVE 1,01.000419.000 S14&N
S Ti;d3 40 MO`P1014 Irk', - RFMD 101-000.241-000 $11.81
ORADMO FEE 101 -000-423-000 SUM)
DW KLOPER IMPACT FEE 1,9U?,tt0
r;
T--'01 . .,QJ(*T9x'C:IT=1014 AND PLAN1C/».k EliOX t2
-PAID VEMI
0100
". OT'.AT.1`: MW niT,SD UN NOW V.4,T2,7.
C ?1( OF LAQUIRITA 'il llllll l l l 111 lull 111
FINANCEDEPT. I
IE 29
i
RECEIPT DATE f ^BY DATE FINAL} INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- 2
Underground Ducts
Forms & Footings
-j3- Z
Ducts
Slab Grade
—2
Return Air
Steel
Combustion Air
Roof Deck
pZ
Exhaust Fans
O.K. to Wrap
—
F.A.U.
Framing
Fit . - J _ qr,2
Compressor
Insulation
. o �jr-f
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
✓ - p,�
Final78�liL $%
BLOCKWAIIAPPROVALS
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 37777,
_3-g 7_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
'2.o z- S�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring �p L
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
i
r
Final
Utility Notice (Perm) -JZ
COMMENTS:
t
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:
79-735 AMERICA COURT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:
Occupancy Group: R-3 Type of Construction: VN Land Use Zone;
0203-383
RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 SO. "D" STREET #200
Building Official
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-18-2002
POST IN A CONSPICUOUS PLACE