9710-122 (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
;71.11in1's 1G�3119"r
- �/ '
�Date� i g n a t u r e of Contrac lie—
K
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.
(v) 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 wor,,K�ers' compensation provisions of Section 3700 of the Labor
Code, I sh fortliGvith comply wit h1- hose grovMions
1Date:11`��� ,Applica,,- fi •
Y ,n ` H,
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, 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. 1 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 c /Ir nssppection purposes.
Signature (Owner/Agent �✓` Dated�/47
PERMIT # CONTROL #
BUILDING PERMIT,.>I
DATE / r VALUATION S1 t .�Si1•cH� LOT . �� 1 TRACT "06188
tlfi�i! 'i
JOB SITE
ADDRESS `%-� y;"�.�1 t�I1'J�1 Lll�1K'!
APN tiE%� tNfB-U.�
OWNER
CONTRACTOR / DESIGNER / ENGINEER
tY::*J',lJ1!{1'C:fti+C.��.I'I`L(I.�C+:yf7l+:lp�yllln*;r1T#:S
4Tl/�.Q�L±.'?r_I.t..�t.:y{t:"1J�:lf,'i'ti:Tft:;�
133 5 So. �lJ� J1 [lf:L�'7'M.. 11 00
1 135 110, ~D" S (\I:i1 1'. SIT. 9200
SAN 10,*RNt RDINC;) (,A W-108
SANT HERNARIAN0 (,A 92409
RI
USE OF PERMIT
'af - AirU{E1tsL ,r� f7f,AN `it�Et. PLAN 0MCK PORTION, i'f3f.S itrf)uC.L-n
79;d k (4( htULT'ff LE t SSUAN(:T. i �F SAitit; PLAN TYPE.
Y RItC! 1.17(ti i KTJt�. l l�`i ^ n n�-
Y>XWJ SF
t1AEkAC6GAkP 0XT 0'S.:o 5F
;F»S IIA'A'AUD L` SI"' OF
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PERMIT FRE SUMMARY
C(fN �TXEk: Cir�+f1111iH. 101-iXl()-4184)DO S7t �.tas
PIAN CHECK rf;tr
1h e Gt1:Ai'41C11k -Vim, if3i`f!{X? i�!•t)t S` ._"�i?
E.JEC'[IOCAL CL -h 101-000.1420-000
PLUNIHING FEE t01-000-419-000
:�'f �;, n 24f. -t•ffi>�t t�_• _ Rr•,�tf) t 4!4 $13,16
R N rti Fi J!-W,1�-2
016UitNG FIX 101.000 1,13•fl00 $.(1•f.►u
®®
NUTRE F 225-0 «14? -342 Vi.4)16.76
tt�•� t Rt1�;"C
PAID
ART IN In3147LIC PLAM - Ri'.'` al, 7(11-000-',65•-f10t) Sl3rr.3EA
NOV 19 1997
01
OI` LA OUINT
TA iYJl Ai.CO?Jw"t'!('f;f,"1'►ON.AND,PIANC't-fIS,K
�•3;i0w.7K
1,LSS i'I,14, AA"D IT.111S
50.00
'i't: TAt, J*ER + IT FERV jf3VE N13'1'4'
$4,401.28
RECEIPT
DATE -
BY
DATE FINALED
INSPECTOR
-Ile.
INSPECTION RECORD'
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Bond Beam
Underground Ducts
Forms & Footings
Equipment Location
Ducts
Slab GradeReturn
Gas Test d 7—
Air
Steel
Combustion Air
Roof Deck
_ i
Exhaust Fans
O.K. to Wrap
2. ' f —�
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
J—//—
Driwall - Int. Lath
'R
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Final
Final - — -
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Sewer Connection —
Equipment Location
Gas Piping
Underground Electric
Gas Test d 7—
Underground Plbg. Test
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 d 7—
COMMENTS:
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
'Final
%Utility Notice (Perm)
.:i
O'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:
79-115 KRISTEN COURT
Use Classification: SFD Bldg. Permit 9710-122
No..
Occupancy Group: R 3 Type of Construction: VN Land Use Zone:` RL
Owner of Building: CENTURY CROWELL COMMUNITIES
Building Official
Address: 1535 SO. "D" STREET STE. #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 5-29-98
POST IN A CONSPICUOUS PLACE