9710-138 (SFD)LICENSED CONTRACTOR DECLARATION
to I hereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) <h License # Lic. Class Exp. Date
LLJ
r` / d l fti: t; r' r i Gr.) i 137
CC
r` Z
Date/�ignature of Contractor
a
Zo
OOH V J '
J U OWNER -BUILDER DECLARATION
HWa 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).
( ) I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
d Q WORKER'S COMPENSATION DECLARATION
oI hereby affirm under penalty of perjury one of the following declarations:
Lin 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 C) ( ) 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
aLOI— permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
°�D O Z1;xtl'f'tl IN3, C,f7. '.'l}fMFkf; tr:
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 that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sh 11 forthwith comply `vi i
p y with those rdvlslons.
,,Date: n pPlicant .•�'"`'�,P „4` 4.
T/f
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
4 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 r
& 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" urposes.
Signature (Owner/Agent) �� Date
11 i i Ir
PERMIT # CONTROL #
BUILDING PERMITS-: %
DATE VALUATION S.� r �� LOT ,r^ t^t TRACT `� 04
+ Y
11110A-7
ADDRESS q1- 1 ASHi K P1A IL 7`N
- �-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C1:": 111 1i1' f;l;e✓IWJ' t.;..t t? �t :<J�`li`t t:;:i
T;CP; : `.!!.Y CRt�;l'.st,l., f�s;r;1l;;1.JM�1'li:
1535 517. "D" SI'KEt"T, S i E. X200
1535 SO. "U" S-i'Et1;tI Sf Ei. U200
SAN' It1:KNARDINt7 ClA 92 408
SAN ii RNAKI)INt.) ("A 92408
t'9+7?►;181-f+t147 f_'Ftl.:t .120
USE OF PERMIT
SP.D
SF0 . t31.a. II1X I1LAN 3KC. RiisT)Ik�'Isu
7W,;, FC)K MIA 1't PIX ISSUANCE trl SAMH PLAN'n,m..
i7tttG'I' CUti:f7litiC 1 tOT3 1,667.00 Si`
Gt+LiZrivirCt�iti'%�ttT •� 17.t:+ii :.ii'
[aw f tib i•,ri ii•>R� t4.L/:� tiit�' '�.{-)ill�fwl' oti€"' 'it i1t
".4 10
ii" ERN'riT t~ i!:f'. SUNINIIARN
PLAN 01FEX HT., tt}t-(ili(1 d i9 ttK 3133.2 R
r~ni,l rRrtc rrt?niia-rC 101-000-4194)0N) $l;i51N'+
X1EC'I IANICi\1, l' L-:: 101.0(60•+621.000 x53,50
MXC.TRICAL FEfi i0)-tiCrf3-4 ttWA1 $115 u3
111AINiRIMI VEIi 101 ilCki-dtU-�Ilt3 3Eaa i t
,'"',"ONO Ku"I'F'HIN PUT, - R_F;S11) 101-MY-24-(X) X9 R5
Kttf Y-2 SiN
�
i
GRAL),N FE.6 101-000-423.0m VW.00
fW-KAa'•rR(J+r11JRid Ft:ji 225•W-443-342 $4215.67
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.IIK
SI ll-TMTA1, (Y)MIMLIC:tT(.')N AN1) PI AN C'FC
` 1
P.110 14
l.C:sS PRE -PAID FEES
$U.OtJ
NOV 10 1997
RECEIPT
A
DATEBG/
D ` INALED r%
(� lX�
INSPECTOR
INSPECTJON RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade - %
Return Air
Steel
Combustion Air
Roof Deck -Q
Exhaust Fans
O.K. to Wrap ?k
F.A.U.
Framing a - 7—QJ
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
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 Quin-ta
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 1
79-210 ASHLEY PLACE
Type of Construction: VN
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Bldg. Permit No.: 9710-138
Land Use Zone: RL
Address: 1535 SO. "D" STREET STE. #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 4-21-98
��-q POST IN A CONSPICUOUS PLACE (%