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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 Busirfess and
Professionals Code, and my License is in full force and effect.
License # J Lic. Class Exp. Date
1 1(rl3me
,4Date signature of Contractor ,
J !
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.
(r!) 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 Policy No. -
;t_ ; t+42t;>g49thJ. .
(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 S, ction 3700 of the Labor
Code, I sh "fI forthwith comply with hos
provisions !
,Date:% r l i,Applicant !.
Warning: Failure to secure Workers' Compensatio coverage is unlawful and
shall subject an employer to criminal penalties and clvil 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. FSI,
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 -i spection poses.
signature (Owner/Agent)
PERMIT # CONTROL #
BUILDING PERMIT
DATE VALUATION �� ? LOT L T q TRACT .98
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ADDRESS `'�?>fjj
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OWNER
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USE OF PERMIT
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NOV
RECEIPT
DATE
BY % ?
D NALE
INSPECTOR
INSPECTION 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
— —
Exhaust Fans
OX to Wrap
— — Q ,
F.A.U.
Framing
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
BLOCKWALL AP ROVALS
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
Water Piping
A,
Heater Final
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
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
cUtility Notice (Perm)
COMMENTS:
i'
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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 1
45-345 BRIDGETTE WAY
Type of Construction: VN
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Bldg. Permit No.: 9710-132 .
Land Use Zone: RL
Address: 1535 SO "D" STREET STE #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 5-12-98
N A CONSPICUOUS PLACE
,�,• JON TANDY
OI 37630 Medjool Ave.
APR 1 `�"nOdlm ' Desert, CA 92211
3 READ Office (760) 772-7192
Eti"AL'INSPECTIONIw Fax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT J 6;At:Iegager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
O
❑ OTHER
JOB LOC17?-
_ t l 0 Coq41e -eeT5ti-
/ A Qu to.,}.f\
REPORT SEQUENCE NO.
TYP OF_�UCTURE
PERMIT NO.
DATE_I
1191
DAY OF WEEK
MATERIALSCRIPTION
- 3 -,� 3
ARCHITECT
I R
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MRS. CHARGED
-�
ENGINEER
ASSISTANTS
MRS. CHARGED
DATE INSPECTION CONTRACTOR PA e - K C,4M&: ` ENEL CON SUB r -
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COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
'HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
GNATURE OF REGISTERED PECTOR '^� `_
4- V1 7qj cgo
DATE OF REPORT REGISTER NUMBER