9710-144 (SFD)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
WProfessionals Code, and my License is in full force and effect.
` O � ch License # Lic. Class Exp. Date
IjCY Lf)
i 14198
t.,
ZO r- Date .%Signature of Contractor � � t. y
t` I.— o OWNER -BUILDER DECLARATION
W W 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).
co() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
rn
d Q WORKER'S COMPENSATION DECLARATION
C:) Z I hereby affirm under penalty of perjury one of the following declarations:
LO
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
O J Q performance of the work for which this permit is issued.
M 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
aLOH permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Cartier Policy No.
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 Section 3700 of the Labor
Code, I sh f( fort with comply with th se provisiohs.
Date: /L � _/7L ._ 7Applican��
/ + i .
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 1.
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
c.Onstruction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectidn purposes.
(Signature (Owner/Agent ' Date �"/fid /e
e, { r
PERMIT # CONTROL #
BUILDING PERMIT 1
. alfIVIR 1
DATE VALUATION v,�7�.Tf� LOT TRACT 1� 1 O
�t '
t cg7
ADDRESS JOB SITE
APN d>II4_661-005.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C111W.TP
cr�rTU.11Y�'�;t�qt''vi.l.c.ct~(c`�syr.It:s
yc:��C111:»ei��.rCE}L1:.€:itsaf;r.:��r�'t'tF�.
1535 •T /. MlJ~ SIL Ri:S 1, tJA 1,. ti tV
!-'1i1 BYO, "DM MTLHE.11- ♦�{ ['.. 0200
-AN BERNARDIN(.) Q`A 92-10H
SA.N IIERNARDINO CA 02r110x
{�ftK?)'ttti •citX17 c",iil,N '2 t .0
USE OF PERMIT
SUD - iYFU, kE1.' PLAN . XII. I-ILAty Ciwox r,0Ry1,-_j" i Op M:S I�Lt�t1�'i11
7+" h014.N11A.'I'IP1,fiISSUAWFsO fiAfvfE,PLAN'I'YPUZ.'
C;;ikRA.Or'C ;W.P0fZT •41 7,06 SF
FXII'1;MA' IZU) MST
93,41 74.
PLAN C1411,CK FFE
C+:rN:"i4Lttr"41C�t3 Fi:1 1411-i100JI8_000 �t� tS.iul
.&II. -CI I1:NWAL VIX tot .OW -•117.1.-0(X)
11LEL: CRIC.AL 1•T -W 101 $115.03
110WHIN0, trial: 101-ft).4199)00 $1.18,04
: )'1 ONG ftirr'> CION F4,17 - IZF'+itl l.all IM -241 S9 85
C�f.A1�IPJf.:1 Iili :011000.42J.(w S204)0
TNFRA. fFIR(A-711JW! ME 225�0W-443-342 S2.215,67
tl
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m-Tcyr.A1,r.oNs-mv.4 nom AWO 1+1AN Clil-Ci`'.
$3,3zn.-;
-,st
- LESS P1:13.1'�,T.F) FS
$0,00
d' n,
NOV 10 1997 '101'Al. PERMIT � EE.N IMF.* NOW
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~
RECEIPT
DATE
BY t
L D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
/ /LAE I -Lr.—
Return Air
Steel
LCombustion
Air
Roof Deck
Exhaust Fans
O.K. to Wrap
—
F.A.U.
Framing
Compressor
Insulation
— Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
3 -2
Final
Final
BLOCKWALL A PROVALS
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
Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plastei
Sewer Lateral
Pool Cover
Sewer Connection
^-Q
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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) -
COMMENTS:
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:
Occupancy Group:
SFD
79-235 ASHLEY PLACE
R 1 Type of Construction:
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Bldg. Permit No.: 9710-144
VN Land Use Zone: RL
Address: 1535 SO. "D" STREET, STE #200
City: SAN BERNARDINO, CA 92408
By: , STEVE TRAXEL
Date: 4-17-98
O phi POST IN A CONSPICUOUS PLACE (/0�