0203-379 (SFD)79754 America Ct
0203-379
t. .
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
14188- B %or 1/02
Date s• `' 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.
( 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 GOLDS Ft&OLFN q Policy No. 1 i#%G-549 +1.03
(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;_provisionv) ,
Date: ti'- f Q? Applicant—'
pplicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety,
for a permit subject to the conditions and restrictions set forth on hi"s'
application.
1. Each person upon whose behalf this application is made & each person'at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information, is
correct. 1 agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) %f + l.. J 'a Date -- / {
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 79-?. hOMMUGA COMM
' W 0 t2-ws
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CET1RY CROWELL Ci91&A1'W >`
'A IRI C1f6 hiMul COIAM J` U1,
1535 80, "IN ;1'dTiEET, STE2, 0200
1.535 10. "..0. BL`.Ct.EKr, —m #200
aAl•$ B1r7S.tNA17DIX0 CA rZ408
SArl .B ERWAYD1140 CA Sr"V W
(509)361.60(n C31,01' 21.20
USE OFFPERMIT
MNSLE SApDVMI.G
S.tr17 - LOT 33 PLAN SX4 ,PERMIT DOES NOT INCI, UDE 1TLOC2C'ityAf LIS,
POOY., SPA OR DR VP.WA'P APl'1tcJACK 73% PLAN CHECK FEE
ELED136:'1ION FOR. MULTIPLE ISSUANCE OF SAME 'PLAN TYpt
TliAVT CONS TRUIC T IO14 21,021.00 8
PORCHIPATIO I Leo sr
OAAAc'! AIARPORT417.00 3F
8;5IZFa7A.TPED O'OIST Off' C011TITPIM" ON
1153105114so
i'i};:RMT nX SIT,41dYMRY
CONSTRUCTION FELE 101-000-418.000 5706.00
MAN CT• EXX FRE 101-000-439.3113 V47.17
MECHAWIC W.L.FEE 101-0004,21-000 $60.00
1Y1,EOT)(1:'1CJ1i,L1i•LZ 101-000 420-000 $137.58
Pi;UMB1NO ISL 101 -000-419-DW S10 0a
STROMO MO'T1011 PRE • i13MIC? 101-000-241-0041 $11,31
C(11 11 O ME `101.13110.42e3a000 1.10,00
1:iVELOPER IMPACT ITIE
/A\ slip" OT'A5,. L 1TC1'1'ON A1+171 PLAN trf$1+tC`In'.
$3,1. x'1.56
=I.W3 PR&PAM 3 L U
".00
F--_FINANCEDEPT
..
CITY® CAQtBI
IIIIIIIIIIIIIII43 j
IE 1
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
- '
Return Air
7-77
Steel
-z
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
—O 2
Compressor
Insulation
-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
o - o Z
Drywall - Int. Lath
Final
_
Final
BLOCKWAL PP OVALS
steel
POOLS - SPAS
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
- Z/ - 2
Heater Final
Water Piping
Plumbing Top Out
_
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
7 -p Z
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring e,Z
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) 77, if
COMMENTS:
b)
X(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:
79-754 AMERICA COURT
Owner of Building: CENTURY CROWELL COMM
Building Official
vwa
Bldg. Permit No.: 0203-379
Land Use Zone: RL
Address: 1535 SO. "D" STREET
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-20-2002
POST IN A CONSPICUOUS PLACE