9710-125 (SFD)F, y1.
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty ofperjury 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
/Date % �IlSignature of Contractor -
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.
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.
�111'111114S.0). z(>•:-w-Yorz
(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 pros sions of Section 3700 of the Labor
Code, I shall fortyiWith comply with those rovisi ,?�s
Date: %%
Applicant-
V_ �/ .
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. I agree to comply with all City, and State laws relating to the building
construction, and hereby aut prize representatives of this City to enter upon
the above-mentioned prop,y for in pect on purposes. i
'
ignature (Owner,Age s = f Date
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION{�•{:��� LOT TRACT
JOB SITE APN
ADDRESS 79-i;;►iti:iT(�'r(�ii.ilt'i . i►it•t-siF►i-{iU3
OWNER CONTRACTOR / DESIGNER / ENGINEER
i��.A�i�iJi�i��.,.i�ii i��i:i. i, �. �:i�i+i�Jiti Ti''. r:i�~i:tily.li���4i��i ve��i.�s ��:1 �iiR iiii'T l•i•t l.:i
I 53i S0. "D" S i It s % si'L'. ii200 1335SO. "D" tiIZZ%:M, 9173. H200SAN 1.11iHNARDINO (,A. ")2408 SAN I:IiRNiARVINO CA 974109
r���;3K+•i�n7 Ci3I.N "f ��
I USE OF PERMIT
IsVD
WO-) - Kt ARi0.i. r`A i>LAN iii. C1IRCK WWI WIION Or is :s IlErJUCE.0
7'!u i• iX AdtJLT11113i ISNIJA.NCli OF SAME PLAN'! YPE.
i 1'.AC r CON S iRVC. i'l0N : , t(t;.(to SI'
GAfLKO&CARPORT 634.06 5F
ESTIMATED C081'01r CGINN'i'I r1"Ji; TIf14N
4430104ft.20
PERMIT FRE SUM fK Air V
N3TRtic."• 0NtFM
1014X*-4lfi•i1N
3T�11(.Ctt)
PLAN 0trCK FEE
101- ttl(.W 9-3 DR
INV 110 TIV41CAT, I"i:'13
•5521150
MECTRICAL hTi
ICt1�(}tx5-ji10•t3(iQ
Si t��. 9
I>I,U NIHI N4I T'Ri.
101.00p -4I9 -01V
Y
5134.78
'ri'R M-1 MOTION FU - R11310
l0}-fli�l-�dt•{1(�
�!3 (N►
CItAi)ililia 11,41M
it14.Oi?(} 3t�3 UO{i
� $20.00
PAID
4NFR.A4"TfWCTURx? i Eti
225-utit�- �t 3. !i2
32,ii� (+
AWV IN PUBIAC° PLACES- - RFSID 701-&A-2 5-01V
GU 1 S 1997
O U OUINTA
"PA -1, CONKMIX_7110N ANT)1'I.,AN 011I?CK Va -CVI ?ft
LESS Plt. MIAID ITES $0.00
TOTAL !'i,itMIT FEV.St 1W F, NOW S4,261.28
t�
DATE ' . I BY / I DATE FINALED I INSPECTOR
r.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
.• a2— -
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
-rc
Final
Final — -
BLOCKWALL APPROVALS
POOLS - SPAS
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
/ -- —
Encapsulation -
Gas Piping
Gas Test
— EFT—
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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) —
COMMENTS:
:.
Certificateof 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
79-145 KRISTEN COURT
Type of. Construction: VN
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
IN A CON
Bldg. Permit No.: 9710-125
Land Use Zone: RL
Address: 1535 SO. "D" STREET STE #200 . _
City: . SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 5-14-98