9710-123 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
mak.
F- Chapter ' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
(V W Professionals Code, and my License is in full force and effect.
=) M License # Lic. Class Exp. Date
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I W _ I<EIR.% la 10!*31/5,7
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o Z - i/Date��/Iq
Ai I Signature of ContraoF� "<<
(O2 � 1
J I.-� OWNER -BUILDER DECLARATION
W w I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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).
cY) () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)d Q WORKER'S COMPENSATION DECLARATION
p T_ I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w l: compensation, as provided for by Section 3700 of the Labor Code, for the
Oro � Q performance of the work for which this permit is issued.
Q () (k) I have and will maintain workers' compensation insurance, as required by
O UQ Section 3700 of the Labor Code, for the performance of the work for which this
rn F- permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier. Policy No.
aD 5 'm'v,n, IN.". CO. =20 W4tW2
n0
Q (This section need not be completed if the permit valuation is for $100.00 or less).
J () 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
3 subject to the workers' compensati'provi i ns of Section 3700 of the Labor
Code, I s tall fort ith comply.wit hose yrovlslon
vbate: �� ��� 7Applic nt
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 tocancellation.
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 inspe 'tion purposes.
r
Signature (Owner/Agen }fir t 114 Date //•
BUILDING PERMIT PERMIT# CONTROL#
.`17111.1 «.i
DATE VALUATION !iLOT TRACT -618 9
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JOB SITE
ADDRESS 79:i25 }gip{iSTEN i'01119T
APN
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OWNER
CONTRACTOR / DESIGNER / ENGINEER
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15- 3? SO, rD"'S'f 031lar FIT'. 9200
SAN f0iRNARIANO t^;,'A t)2408
SAN 1W.'KNAR INO CA 9240N
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USE OF PERMIT
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jig's VQR Mft)E.'t UILF; IS' 0ANQ1i (.4 :IAMB PLAN 'I'YVE.
Til: ACT c0a,:r"I'i2t3i'1'foN 1,r,03.00 Si'
GARAGU.JCARPORT • 24.00 511"
• Egf MkTUM COST C3>`+ CONSTRUCTION'
lt,Ys;4..13.319
PERNUT k'1" R SIMAMAR'Ir
t;t tN:r"fl2Lf�'7 icJ ri FUE 101.OW-418-000 3t',CfJ-10
PLAN 011 -UX VM. 1014W -d39-318 $07,W)
NNE 1tMIt;AL iZiii 101.000.421.000 153 50
t—i1XICTIOCIIAt. �f itll Gt7l�-�i'0-Cst1�3 �t ,gra
Pi..UA41AINO PT..E 101.000A 19-0€ 0 e_ � 1 M.7s
,T1'R()N0 NfCl't K)N VFR _ RPSID i01-f1(iiF-241-0M ' 'r $;kf,2.
GRAVING FL, 101-000.4 3.0W x:00)
PAID
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ART 1N 14tUIC; PLACM..; .MSIC, 701-01 254,6ft)
NOV 191997
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$0.00
'f'U•GUA PERMIT k EKS DUY, NOW
$3,.550.72
RECEIPT
DATE
BY !
DATE FINALED
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
O.K. to Wrap —
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 S
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 S- $
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection — _
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) S�
ELECTRICAL AP ROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Factures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) �/ -
COMMENTS:
Cf
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: 79-125 KRISTEN COURT
Use Classification: SFD Bldg. Permit 9710-123
No..
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: 'CENTURY CROWELL COMMUNITIES Address: 1535 SO. "D" STREET STE. #200
City: SAN BERNARDINO, CA 92408
�d'h7
Building Official
By: STEVE TRAXEL
Date: 5-29-98
POST IN A CONSPICUOUS PLACE