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0106-340 (SFD)U) H _N U) W E):) C) W oZr- 0. 0 J Wa U) Z L N O� �a Lo 0 LL 0 W J m< 11 rn H I'd, Z cb O Q J 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 7141 SS "a r- , 1.t7y i 1 /2'C Date °` d Signature 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: Cartier Policy No. 00L ASN RACIA 110. Ali f. 4 3ABq-I};� (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. Date: �!._.•-i`.. Applicant ��:'� �a/g,,.•~7'� , Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent)-)"V) , i -^"yrs; r, Date/ _ - BUILDING PERMIT PERMIT# DATE VALUATION LOT 01064MO TRACT aaq 24197-1 JOB SITE APN ADDRESS as DAMD AM DIME 6(K4)72 -W6 OWNER CONTRACTOR/DESIGNER/EN (NEER 1535 30, 43" 9M'f�XX . ERE 0200 IM S(1. ov ;�r3REI.1, STE 0200 SAN 331w1NARDI NO CA, 924,08 SAX HMMA$ DWO CA. 92409 USE OF PERMIT SYD . 10T? PLAR 4I:3R, • PPCRib IT }: ORS NOT INClrUDY, RI. ICK W AL1, 1001.OR UWWAY APPROACH, 7514 PLAN CFIU3,1I?:'REDUCT.1014 APPLUM, FOR 1k2UI,` 1PL.Z PI A;N'Plr`PES 5°UBMI'IT)U. MA.CT CONST R.UC` 1014 12100100 OF PORCIN/PtI T .10 62.00 SIS (}AM4' WC!AaRPOTIT 604.00 SF .xw9.Lb".H.R.k.'+i✓/' 6iovi 011 7%OJ.vSS.7.6U4+d:AMN CrANVAUMIM F.%B: 101-000-418-000 MAD PLAN CaH.!"CY irolIs 101000-439-318 000.4E:S9.318 $I14,39 MECHANICAL K.9 101 -0004 Z 1.000 566.150 3, C F}I.t'I sRt. 1014) 42(t-R:1$1i? $153.33 PLIU°M01140 FEE 101-1,100-419-001 $142,00 S;f'3tGtiH01MOTI;�'N FFS • RESID 109..,010-2A17000 $13.66 ORADR40 MV, PIAN DWEL.OPAR1MRACT FEIN: EITM-TO Aa.. COa r I MD 111AN C"F:L4if:"•M 1. MM PRU-PAM FRES w CS.00) 1. ALA H S Ld'� ka3J .SP l'.Sw HOW 4A•�Sc�PAN XI eF ka, i RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD t ,. �t } t k t I! i. { k= } }!I f t. 1 ,E r t k tl � RI OPERATION DATE INSPECTOR OPERATION DATE 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 Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall _ r-A _Exterior latht__Drywall -Int. LathIj! � 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 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final jo:�IX 9f'�I�2 /V � � ° •G• ��'f� Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Serv ice Sub Panels Exterior Receptacles . G.F.I. Smoke Detectors Temp. Use of Power Final -- Utility Notice (Perm) t ,. �t } t k t I! i. { k= } }!I f t. 1 ,E r t k tl � RI OPERATION DATE INSPECTOR OPERATION DATE 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 Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall _ r-A _Exterior latht__Drywall -Int. LathIj! � 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 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final jo:�IX 9f'�I�2 /V � � ° •G• ��'f� Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Serv INSULATION CERTIFICATE This is to certify that insulation has been installed in conformance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building located at: 79-811 Dandelion Drive, Lot 7, Monticello -Heritage, La Quinta, California CEILINGS: TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38 WALLS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13 GENERAL CONTRACTOR: CENTURY CROWELL COMM UNITITES LICENSE # BY: TITLE: PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 BY. TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002 Certificate of Occupancy City ofla 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: SINGLE FAMILY DWELLING 79-811 DANDELION DRIVE Occupancy Group: R3/U1 Type of Construction: Owner of Building: CENTURY CROWELL COMMUNITIES -T-,,, Ak- Building Official Bldg. Permit No.: 0106-340 VN Land Use Zone: RL Address: 1535 SO. D STREET City: SAN BERNARDINO, CA 92408 By: GARY SHOWALTER Date: JANUARY 25, 2002 POST IN A CONSPICUOUS PLACE