9710-118 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
O rIli IRS I3 1u/3119',
Z r- Date gnature of Contractor
co 0
JI.— � OWNER -BUILDER DECLARATION
HLU r1_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
C () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
C7
L)< WORKER'S COMPENSATION DECLARATION
C, Z I hereby affirm under penalty of perjury one of the following declarations:
LO
p () 1 have and will maintain a certificate of consent to self insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U ()' I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carrier Policy No.
ob = 7041 *1 T I - 14N.'11, iii, t"c`�►"'iifiv`
C
J
(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 shat forthw'th comply witl�.th �p'rovisiops.
Da� te: / J AMplicant - �' �
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.r.
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 for inspection poirposes.
Signature (Owner/A en)Date/Y
.-r-
PERMIT # CONTROL #
BUILDING;PERMIT quotlis 1
QQe
h V T
��+� `s
DATE L1 /j(, y VALUATION LOT TRACTJOB
SITE
ADDRESSt 79-140 KR.ISTEMOURIq
APN alT4-Gtrk-fTU3
OWNER
CONTRACTOR / DESIGNER / ENGINEER
GIZ "It RJR Y C; R,01 11.0, 1. C't:� 4411164MrI'IES
02,119 TRY :.'.''%Q_V- 1-1,L t.ON41`:(11"111F.i
I 574 SO. `D S1'KL•'('I', M -F. #200
i535 s0.100 81'REf?T, SIR #1400. •
SAN I3TiftNAK.1)IN(.l (,A 924UH
SAN t.T}sRNAK.l. ONO CA 92408
(;i1T,fi ?i^Q
USE OF PERMIT
SIT) - IhiARKI-T ,.A PLAN 3AR
';uAc 'i. 464M SI
! tt♦ 14lti .i'i�iif WST OF 1'O1iIlltU 1U ♦
Ittk,it4.0 . j,
PERMIT FFIR, WAMARY
CON!(TRIJ rIC)N FEE 1014 U4-418-ti(i(t 5748.00
1+14AN4`1 (X VVI 10li-()—1113!J-W V16'.1;x
MTKIIANICAL ME IJI=� d:t'C�0 fSi�.S(3
U1,EC R fCAk, FFX3, S I Xask
PLUMBING F ETs Si 44.75
C3i{A1JTT3�i €,�? iT)i I)(Tt3-•!�;•t?4t} 3'U (1iJ
RA I D
�N3�2A,`3Tl2ilt.�'t'tlfti~ �'�T3 ��?•(1t7�I4�..ial2 �:w�."•5,3�Ka
AWr IN f't1Tai.ff )'I.J1rr"i~'.`1 - R Iv 701-000-255 i S75,10
NOV 19 1997
J
9 JB -TOTAL CON S7RUCMt:11+tAN D PIAN tJi
T.4,723 -i7
x,L'SIS 111:13-1•'AID FEES
50.00
TOTAL PEt+CMY1,• FEES 101: iVf3W
54.723.37
RECEIPT.
DATE
BY /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
v
DATE
INSPECTOR
OPERATION
DATE 7
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
_ $—
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
gt—/(- t y7,
F.A.U.
Framing
-
Compressor
Insulation
_ful
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
.4A
%
Final
Final
—" -
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
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
_ 6
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
Final
`Utility Notice (Perm)
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 1
79-140 KRISTEN COURT'
Bldg. Permit No.: 9710-118
Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL Address: 1535 SO. "D" STREET, STE # 200
COMMUNITIES
Building Official
.City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 5-7-98
PLA