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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
'71419810 $4i.+U99
Date � a ' �gnature of Contr etor
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).
( ) 1, 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 thework 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.
2 f A"M INSX0. ' "' •t2CNs'?ZiS'f v.
(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' compensatl'on�fevisionof Section 3700 of the Labor
Code,.I s all fortF�,with comply,
wl t, ose pr•visl ps.
Date � `a 3 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 hisi
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 f
& hold harmless the City of La Quinta, its officers, agents and employeesfi`
2. Any permit issued as a result of this application becomes null and voids
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 inscion purposes.
Si nature (Owner/A ent�1 Date`''`
41 ..t
BUILDINGPERMIT PEFIMT# _ °°NTR°`#
`S
9804-0418 000yyy A ^ �r
DATE • VALUATION LOT TRACT. /„l { �y
S4,27•�.4 * N 5
�.
t .
JOB SITE '/
ADDRESS 79430 KICi1��iITA N COUJU �41c%KL C./'A �RP
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Clif-,19 JR V CRf}l1rEi' L COMM{„Ntnv,,R
$33 O. I'D” S'$'•t fr?"T,,S'$'#i. #200
i 3:i SOC 4:U" S1'R:F�'F'T;;S'CIr°'. sN?.UU
SAN,8ERNIARIANO CA. 92408
SAIN BE,RNAR.1 -NO CA P2408
(9(i 13$3i-GO(!7 C3! IA 21,20
USE OF PERMIT
�iJ%�'i.�d�fNsit"T't1i:'i41 P��ii$ u`�7'zfril9, �.,�i�13�itsfN4J �L� ic`� �•.12�3N$?E„• .
'ro 23t3. 1rAi,iNA`1'1(Jh:�3 .AN1:� t Q��'1`{r�i'kN `�T't!"$' I Pit's 35.fJf tittlsNt;t�
Eba.i'WrIMN THE TWO PLAN 'i'l'PO%,
GY'kRaY3Ar U%.k4P0 S .x.!8.0-0 3
�
,DULMATED COW OF CMSMUCT."GAN,
PLAN C DECK 'IFEER1 Ul. �t���'�-� !8 $424.99
CIONw'T'I2.caMON Kit 101-OM418_000 S*14.N)
N=F dfCAL FEE' lot -000-1-m-009
LIEC'TRICAL F..86 84.36
P:s:,'U 1NG F E 10340-419-000
STRONG NCC'TTCN't»rIjO, - MID 101-(3 -141 4100 $.43
GRA' UNG i°ER .101-000--M-NO
ilVF RASTRUC TUU,.FEE X25 -OW -44342
ART IN tPIOVIC PLANS . MICIO1-M-255_000
•.
t„ti
r _T Al � (�pN:+ ? UCT ON AND PLANT 1' IEC K
$ 546,1.x.
APR 3 0199 LESS- P -PAID ES
50.00
�.
®�: r•
rRECEIPT
DATE
BY
DATE FINALED
INSPECTOR
;'".'
I. INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_p _
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
(e -- (q _-
Exhaust Fans
OX to Wrap
_
F.A.U.
Framing
_ iy - 99 1 ZT,
Compressor
Insulation
,.�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
— l
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 Lines
J—'�� _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
(� - 2 3 -
Encapsulation .
Gas Piping
Gas Test
Appliances
-
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
i -
Final
Utility Notice (Penn) ��
Ce:rtificate 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: 79-130 KRISTEN COURT
Use Classification: SFD Bldg. Permit No.: 9804-048
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM
-7;�,
Building Official
Address: 1535 SO. "D" STREET, STE #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 9-30-98
POST IN A CONSPICUOUS PLACE