0106-338 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Cv W Professionals Code, and my License is in full force and effect.
=) co License # Lic. Class Exp. Date
I LU
r1_ tY / 141" B
,
Zr- k_/Date r Signature of Contractor
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(D _ �
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C-) C:) OWNER -BUILDER DECLARATION
Wd r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
(n 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).
Ch () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
CL
p 2 Cr I hereby affirm under penalty of perjury one of the following declarations:
Lo <O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q () ( ) I have'and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
� Z Carrier Policy No.
oD O fi!v' i. 11' PA01.ry IM WI WC.5*l0681-+03
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,
d 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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
.Date:Applicant , *r� ",�`.,. -7 i X , ,
'l," ��ryf�, r?•^�p1 .".P ~ag' ,i /?4.rt;; l+(.,'+,1'CiQ•",/
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.
u J Signature (Owner/Agent)' !' i''1 a, + .r - "�''`.>C - Date ✓- 1 j
a 4 I v •�.. e, -. 3 tG
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 03,'3M TRACT
5 74197.1
JOB SITE
APN
ADDRESS
19-W39 D.APDY1,1f�1� 0M
-Ca' 24W
�NEER
OWNER
CONTRACC7T�{OR/DESSIpG�NryE/R�/EN
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A%s7 L� .L 4dG.V GV.L':.6wA.� C��/J..iYJ.LJ 19aS,E A3
SAW REi%NARD.D4r4 .? CA 92409
SM BER t,�?..i,TNO CA M 09
(909pa1..{OV7 511 2120
'
USE
��O�FyPERMIT j� p�. f, }gyy�Jyy� 4 `�,�y/'�
6�SI.�1OLE, f.`ZYLt01 )"r.1J1rIP3.111�71RO
1
SYD A I.,R T a FLAN 4W3, •, }a11J1WT 0093. Nat f0CLAJ09 BLOCK ii A.."J'5
POOL ObiP3RNIMAYAPPROACH, '7$14(s1AWG3''1W-YEZ14BOUVD014
.APPLIED YOR MUVrIPLE P I-A,N '3'YP E3 SUBMITTED,
TRACT CONSTRUCTION 216.X00 SF
sp
PCAiPECA:W;tP>M��."�IOTy
W 7 J162.00
rMMHY m gubLMARY
t"ONZI:1`RUCTION IY',1`,? 101.000-418.000 5 39,00
PLAN C'kIkCK VVE:E, 1.01�000-439_318
MILPC •;.; NICAL PER 101400-421-000 $66.50
6JW7RJCAL FEE 101-000.420-000 $153.1.93
F1a3.pMB510 k'XX 101.-000-419.000 $1= 2AM
VFt.d5NO MOTION FE1,1 v'xBSID 1Iii-000-2.41-i' 00 $13.66
11.' �I1�Yd31Si1.01.000.433.000 $20.00
rJz�'•11�r..OP1!�1� IIv1P.A.03' F�;IL �I,90'�:00
ffUB-1VfAL CiOMMUi"7li:2N": NDS P,l.A-N CM,. 'M
X3,31 G.a?u
- Rj J�32 is FESS
$0.00
PMOM DAYS NOW
JUN 2 5 2001
R EIPTB
FIN NCE DEPT
DATE FINALED
INSPECTOR
INSPECTION RECORD r
if
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR t
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs G' Underground Ducts
Forms &Footings � (7 � Ducts
Slab Grade / ZC�/,�/ G/ �J/�/ Return Air •i
Steel v/ �[C Combustion Air
Roof Deck �� D _ Exhaust Fans
O.K. to Wrap _ _ Q F.A.U. %
Framing 9/10/ ��, _ - _ _ Compressor
Insulation Vents
q�l Vents
Fireplace P.L. / Grills ( >I
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
FinalPOOLS - SPAS
BLOCKWALL APPROVALS Steel t
Set Backs Electric Bond '
Footings Main Drain I ,'
Bond Beam Approval to Cover
Equipment Location r
Underground Electric r
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 /Z, �O1 Pool Cover
Sewer Connection Encapsulation I
Gas Piping {I
Gas Test
I
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)p� �— —
ELECTRICAL APPROVALS {
Temp. Power Pole
Underground Conduit
i
Rough Wiring `
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
jF
i
Final
Utility Notice (Perm)
12/12/2002 THU 13:23 FAX
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, Stale of California, In the building located at:
79-839 Dandelion Drive, Lot 6, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CertaInteed Thickness; R-38
WALLS:
TYPE:BATTS MANUFACTURER: Certainteed Thickness: R-13
GENE CONT TOR: CENTURY CROWELL COMMUNITITES LICENSE #--.Z/fffz
BY TITLE:
A ud2a=40�41 66
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
[a 004
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: SINGLE FAMILY DWELLING
Occupancy Group: R3/U1 Type of Const
79-839 DANDELION DRIVE
Bldg. Permit No.: 0106-338
;tion:VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMMUNITIES Address.: 1535 SO. D STREET
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER
Building Official
Date: JANUARY 25. 2002
POST IN A CONSPICUOUS PLACE