9807-063 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
714188 B 10/31/99
Date 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:
Camer GOLDEN EAGLE INS. Policy No.
(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 provisions.
Date: Applicant
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
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, indemnity
& 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 purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT9807 063 A*11 r
DATE VALUATION $134,556.80 LOT 85 TRACT 27899
_
q -/H -W
JOB SITE ?9-180 CINDY COURT
APN 604-362-037
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENTURY CRO'WELL COMMUNITIES
CENTURY CROWELL COMMUNITIES
1535 SO. "D" STREET, STE. #200
1535 SO. "D" STREET, STE. #200
SAN BERNARDINO CA 92408
SAN BERNARDINO CA 92408
(909)381-6007 CBL# 2120
USE OF PERMIT
SFD
SFD, LOT # 85, PLAN 4B. PERMIT DOES NOT INCLUDE BLOCK
WALLS OR POOL.
TRACT CONSTRUCTION 2,240.00 SF
PORC"ATIO 36.00 SF
GARAGE/CARPORT 635.00 SF
ESTIMATED COST OF CONSTRUCTION
134,556.80
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $762.00
PLAN CHECK FEE 101-000-439-318 $631.29
MECHANICAL FEE 101-000-421-000 $53.50
ELECTRICAL FEE 101-000-420-000 $139.60
PLUMBING FEE 101-000-419-000 3152.75
STRONG MOTION FEE - RESID 101-000-241-000 $13.46
GRADING FEE 101-000-423-000 $20.00
INFRASTRUCTURE FEE 225-000-443-342 $3,016.76
ART IN PUBLIC PLACES - RESIC 701-000-255-000 $86.39
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,875.75
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$4,875.75
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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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 Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
I013iiN
,/Date, , Signature of Contract
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 contractingwithlicensed
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 penal,ty,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.
(`x) 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.
(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
Co'dshall fort4iw t4� comply with those pro sio /ate;?-' Applicant
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
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;t
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 inspection purposes. `
/ignature (Owner/Agent.) Date ,k
�r
PERMI#
BUILDING PERMIT �} 11 9
DATE VALUATION 34;';$6.01 LOT S TRACT r 7X99
f1,'IJ�
ADDRESS '`lY-liiliL��Lft3k t.*vl/Sr.1 JOB SITE]
APN 4PO4-3)61-6
OWNER
CONTRACTOR/DESIGNER/ENGINEER
r►:t-r1rvrnvr�nL�lrl,rc �f�px 1rtA,)t"�r�
\J..�S V \Jf IA..Id
;r. alt rna'(p�c,l�Jxrgl rraa<��a �la��lr:r
t..1 V 4 ;J 14. l \.+[4V OY, .. 1d Ar �,.!,.,,Y[�Y[ t4.,. [ AI -:1•J
6_15 `O, 1114 1f t{IZIII iS. M1
B-35 SO. TY' ! 1NZEM, STE. 5200
SAN PERNAitl.)7NO t:,'.A. WON
SAN 135.;. NARDINO CA. 9°2,409
(qa! im1-60 -, C'M-4 21.20
USE OF PERMIT
SM. i,u.i 4 its. PLAl3 4B. T'EAiivil'!.° DO&Sl NOT INCLUDE BLOCK
Rm. ! ✓'.Wa f �a19 .�al,.t9i �/V, .'i Y�'1. •• R\ +Y � ✓•.
t=la.Rt Ai'!C1 )G.4U Sl
Q4AKA0F)L;p1f2K,lt't' (s35.1ff) S1<
.UST#1IiD!U (:USC OF CO"SYRUM`CIN
13111.11561.)
j3-44.fIPER, SyMM0.Q3
0-JK3_F tltC'C!,€?N,k"F#? 10J. -0004i841100 1762.01
KAt�cgyry,fF)CK+t+O rIQ I ta./y$6711.130
18 $6
Y }-fD(?fl.,y
1.
lis ','QT4ilt';#li..1.5f 1,01-000-42"00 $i.s��.'l►
PUINUAI NO FFE 11)1-cIOD-4.19-M)
I'I3ONGt1.St7'It'}1V 1•'l-F7,..:tf SM-) 11lf.(ft)fi 241401 s!3.16
G12AD.tt O Ff-r-_ 1.0t-0,1)-423-000
(f\Il fC11"t'f'Ctlli "I*l11{1. t;.t l: '225-000-443.34,t1f.Ei:7G
Af Y fN Pt.lBIX PLAC'178-.1t_E3113 701-t)(10-25540) �ify+5.39
t,
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S1 JR-11MA.1, C,ONIKIRCX 1NON AND KA.h1ifF,CK
$.J,� 7f 75
J_.Es a PIKE -PAID FEi?S
A, I
SEP 14 1998 '
qE Ili ;:° q ,a n^ ;--',a A
RECEIPT °
DATE+ S 6 U i
BY
DATE FINALED
INSPECTOR
,t4: S
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms & Footings
Ducts
Slab Grade 27 7-- F Y
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap a — 3/—Eft
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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 LinesHeater
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
d/
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)7,7