9710-120 (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
71.119ti 13 _ I(W!1147
Date �� - /lSignature of Cont r ctoo
I
OWNER -BUILDER DECLARAf/TION
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:
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
Code, I, shall forthwith comply with All e , i io •• s. /
%Date: �J A �a %T7pplicant 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
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.
BUILDING PERMIT PERMIT# CONTROL#
DATE VALUATION 5�.'Si(i.J>O LOT ��^} TRACTJOBSITE'
ADDRESS I l9-120 k. 1M -A t C0TJkT APN 604-661-0 03
OWNER CONTRACTOR / DESIGNER / ENGINEER
/^t r! R.IP 4'%)i:.) wIVEI'll t:G! V RITINi'1'1:;5 t::`:"!'rUllY c1lo :/!i.,l, CC?ItIA.UTdrrfFS
• ...
1$35 SG. "I3" -KI RZI f. MI. 0200 1535 :SO. "i_r" STI2.EM', MT.. ,i20
MN BERNAI(I)INtJ CA 91,ulx SAN !.11zkNAIL131NtJ CTA i;Z;t(>M
(rKl!?13R[.t�4ifi7 (;i�i.fi ;viii}
USE OF PERMIT
;FRi - AfARFIE LA PLAN ,IBR. PLAN CIMCK P 'kTION E ,r F ITi5 R2[it U E D
7 ,'a F(._1K T VI.fdPIX IS UAN 1" 'DF SAMI; PLAN WPH.
110ft011VAT10 X00 SF
GARAGOI1 AKl'OKY St;
ESTIMATED CUST OF cf."ANISTRUCTION
PERM IT F. Elf" ,SUNIA1.1k1t`i'
C 0N: TRLJ1ZI7A_-+N FFR
101-d1W-M&t}(1(1
S7rr;!.Ikl
PIAN Ir.1111-c"k, 111,011
t01 -(M• 1.tt8
NIXIIA•`.NICAL 1711,
101.000.421-000
t'7.5G
L(111,If_14ICAL Ff"Al
I(it *` 0-420,000
sl ►�r.�i
PLUN INCi Fla.,
101-()0()-1119-()Cti)
3f52.7..5
i1�2tlNt"thi '1'd0IJY+'i2;.1XRR]I?
MADING irCUltit-IyilO•�:.3
t?(Y�
$'.:(l oo
JNFRA!rf (.UR..`1 iTRR FRE
225-0040-342
ART IN i-jirKIC IILAc %'s 7old}( -,25S-f►t)o
SK5 �9
Y i
SIJIt•Tn'1'111, C�n1`r5"TItL1CT1pN AND PT,t1r) r'I lrcK
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.
/� RECEIPT DATE BY
Signature (Owner/Agent)/ •-a +% ^ Dater
PAID
NOV 19 1997
FOPLAOWNTAj
DATE FINALED I INSPECTOR
t
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
7
Underground Ducts
Forms & Footings
Ducts
Slab Grade
-- fy
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
2..
F.A.U.
Framing
11,¢ —
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
3 6—
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 Lines
-] - ,3/- P?X,
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
a
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
_
Utility Notice (Gas) -
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Pictures
Main Service
Sub Panels
Exterior Receptacles
G' F.I.
Smoke Detectors
Temp. Use of Power
lFinal
161.1tility Notice (Perm) 7T
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 3 Type of Construction: VN
79-120 KRISTEN COURT
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Bldg. Permit No.: 9710-120
Land Use Zone: RL
Address: 1535 SO."D" STREET; STE. #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 6-29-98