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030-155 (SFD)I— N U) W O CY � � W r-- o Z coS0.11— . H 6 W W I— a Z, M LO N ON L) a) a. g NT Z 02 ,.Q O Q J' J m< O a a) 11, Z Cb5 1`77a .g 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 //7141815 Z 1171�e& „,,�+13131 /2+t ate`` ''�Signature of Contractor W11 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 t 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. A, ) 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 rt, permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier S`T.ATF, FUND Policy No: 1034091-02 (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 those provisions. slate: '/ r,._. ,, Applicant— Warning: pplicant 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 authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) rs''a°°'< %f' !r Date BUILDING PERMIT PERMIT31 11?: 1: DATE VALUATION LOT TRACT S.1 116 428.10 'x d 24.197.1 4, -,Z JOB SITE ADDRESS j-%.J1r,3x1tiMM 3fFFJON DRfVE APN C%14-072-004 OWNER CONTRACTOR / DESIGNER / EN (NEER 0MTURY” CRO'S�t+ .I,� COW, U9M CENTURY e-43RO E11(".OMMM..-AM9 1535 so, -t mm,;,SC vrx 42(30 15:35 a1 -;C,'3,)" �,",i'• Tt RIT, STL. x.00 am 'BIMThbARDINO CA 91408 SAW DIER +1ARD190 CA 92 403 (90{d}381 Low CBI�i n zo USE OF PERMIT SFD s Lk3T 43, P1,.,kN 5BR. I19i2W IT 1:YO&S140T INCLti"M BUICK WALLS. P004 SRA, OR, .DR,IMAY APPROACH. 19% I;Is'DUC`I'ION `k O P1d:13 CHOCK Aq&S D'IXE ` O MUL'EIPLZ ISGUAHC�1? OF SAME PLAW TYPE TRACT CCR"') UCT1014 31012,00 Sit PC1RC,HIPATTO ;i1,00 SF OARAC EIVARPOV 640.00 V :���� c.�cy��ear' �ca�T�►����ca� � °r���a�•�.t� CONSTRUCTION FEE 101-000-418-000 S.".9.100 PT. AN CHECK I9L 101-4100.430-318 W.CHA ICA1..:i:'I;�ro 101N000-42:1.000 moo Z1.SkI'!'T':if;:AL PIF : I. 101 -000-420-000 $ee6m, PLi3114131' O FEE 101-000419-000 1 .Refs S1°120NCt MOTICJ14 FEE e USIID 101 -0 0-241-0,00 'M.64 G ADYNO i?Llra.. .>,. 101.000.423.000 b19,00 IDFVEJ.D".P'ER IMPACT V!;'a1. �3,fi0�.0ii PJ,vs .4t,, ��! 3 /} Y W► t p :..•� ...., t� AND �� 1 CTWCX 113,941.:31 1�r.�"u7 i�7:2�•T�l�1:t7�+�'i5" :�(3.ttC� APR 0 8 MUM EBMT MiS I E: TOW _ CITY OF LA QUINTA FINANCE DEPT- / RECEIPT DATE BY N I SPEC INSPECTION RECORD OPERATION DATE INSPEC 'OR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & FootingsDucts v Slab Grade Retum Air Steel Combustion Air Roof Deck _ "O Exhaust Fans O.K. to Wrap _ _ / , F.A.U.Framing PO ✓ 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 s �if� Final Final 1 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 APPROV Gas Test Waste Lines _ r _ -� �T _ _ Electric Final Heater Final Water Piping T Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ Pool Cover Sewer Connection v/ Encapsulation Gas Piping Gas Test / Appliances Final COMMENTS: Final Utility Notice (Gas) ©� ELECTRICAL APPROVALS Temp. Power Pole Underground ConduitEll Rough Wiring L Low Voltage Wiring Fixtures Main Service _ Sub Panels Exterior Receptacles G.F.I. _ Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) _� f - Certificate of Occupancy T.�. I•corroutrn G� OF Building Y p & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 79-755 DANDELION DRIVE Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0303-155 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: CENTURY CROWELL COMMUNITIES Address: 1535 SO. D STREET #200 City, ST, ZIP: SAN BERNARDINO, CA 92408 �--� By: BILL GORDON Date: 09-03-2003 Building Official POST IN A CONSPICUOUS PLACE