9710-139 (SFD)LICENSED CONTRACTOR DECLARATION
G I hereby affirm under penalty of perjury that I am licensed under provisions of
K Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
WProfessionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
oZ�DateSignature of Contractor _
0(D OWNER -BUILDER DECLARATION
W W r- I hereby affirm under penalty.of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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). ,
M () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
O�
d Q WORKER'S COMPENSATION DECLARATION
'Ito z I hereby affirm under -penalty of perjury one of the following declarations:
U-) Hcc
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q U (wJ I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for, which this
Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
19t Z Carrier Policy No.
c^D O 7.rIN11111 t INS. Co. 2!> I2W-11.4'
J (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 t t if I should become
subject to the worfers' compensation rovi s6s of Se Ion 3.700 of the Labor
Code, I shall fort itFti.� mply with those visions/
VDate: �/ J �U PCpplicant
Warning: Failure to secure Workers' Compensation goverage 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 4
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
fthe above-mentioned property or nspectionJpurposes. t
�1 Signature (Owner/Agent") / -Date Id I7 1
BUILDINGPERMIT PERMIT# CONTROL#
(4710-1 L6,205
q
DATE ! t�t�J �1 VALUATION S 105.247 11 LOT s! TRACT 6,2 0 w
V V
jjf
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
,:(lI.IF. :iL
1:1'i SO, ".lice S t"RE ~ F, SM:. ii2W
_ _45 :if..l. "D' t��t�5�„�',-
%AN BERNARDINO CA u3d1)H
SAN BERNARCAN() 4.;1'1 9140X
USE OF PERMIT
tij7
c tip-1:�ixt iiiii' I'I r1.h1 314k. KikN i.'11L. K PORTION OF Ii ECS RElZOMT)
714.)RM0,11111d:l'1%,M3ANC,'1;(SAM14, PLAN't'i'W,
GA1tX'AYCARPORTn )o SF
;i1' "'D t.t?,ST Ole CON .1� 1'.111 "i"WN
t1 t�'p i l �L �li:.Y�,TI
7[ 1iTNO j 61"Fill SlxlEii.t�'lr RY .
111. AN t'1.1E(,'K FFE S137,45
0*)N;:'IRkf(,-n()A11:l31; W400
14fI701AN ICAL F1.113 101 -OW -421 -OW A10.;tt)
)sU..,k;I tJ(3A1,F1'sF; 401-0W-420.OW $1'.1.1.65
131.VNfSiNG FEE 101-(9)0_1119 0) 'S1484K)
01Y111N(l NIMION !,J. - iii!1R!0 101-01191. '11 -ox) V0,52
t:1I:,AVING 1,01 101.0010.42-1-000 x'2t),Ixl
ISI27-RAz;'rR0:; t`jR.Cs FU 22S�443- 42 $2.368,lyi
ART IN PUBLIC PLAC''I•;3 - RESIC 71114%-255-000
i
1. -"ij i r11,f"t' N "]'T?LIM1(7N ,NNf PI AN CJ4E,CK.
_L
t, ” LESS ITE -PAID PEES
�f3.Ut1
NOV 10 1997 '�"ca�t',�.�: PERMIT ��E.i�S x��r�, NOW
RECEIPT
DATE •
BY'
Cr47 Ul`
INSPECTOR
AfY.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms S Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—16 — 7.9
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
—f —
Final
Final —
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
— G
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)
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: SFD
Occupancy Group: R 3 Type of Construction:
79-190 ASHLEY PLACE
Owner of Building: CENTURY CROWELL
COMMUNITIES
Td's
Building Official
vti
Bldg. Permit No.: 9710-139
Land Use Zone: RL
Address: 1535 SO. "D" STREET STE. #200'
City: - SAN BERNARDINO, -CA 92408
By: STEVE TRAXEL
Date: 6-15-98