0106-354 (SFD)H
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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
714188 0;6* .33 1( a ► i
Date .� f' Signature of Contractor'
t 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.
(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: % •� l Applicant '; ;,t > — •' .
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 persontD
whose request and for whose benefit work is performed under or pursuant
any permit issued as a result of this applicaton agrees to, & shall, indemn
& hold harmless the City of La Quinta, its officers, agents and employee
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of suc
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 i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. ,
Signature (Owner/Agent)` 7` 1' f • 4 ? ar' Date Ll
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 010&3.vA TRACT
24197.1
JOB SITE
ADDRESS
APN
7 4 tl' M►�4"`t.'.101? I) VE
(O"IM-11MG
OWNER
CONTRACTOR / DESIGNER / ENGINEER
t':1:NITIMYCROWEMW11 .AT.J��MS
CEN"nmya:C)'dELLCOMWFN1"T',LES
1535 iso. D. uwwI., `.riz 42,00
1 11P5 so, 1>0 Mf23-W, "WE IP:ZOU
SAWB1'RNfiM1.NO CA 92408
SANT DOWAIdDAA O CA, ON0FS
(9139)381-6001 CM1119 2120
USE OF PERMIT
SWO - LOT V PLAN 4C - PERM.17' DOES WUr'NCIAM SIZCK W'ALI,
POOL 19$3.NMA"f.'APPROACH, 75% Uzi. 10HEC"•11 ne UDU0110-14
AP'MLE0 M.R. MULTI i IA?, PI 04 TYPES SE3B1ti ITTEP.
TRACT COWSTRUCTIUM M00109 S9
P001.cHARN1'1O 67.00 sr
GARAOWAR1Pk1,'1' 0&1.04 OF
u`". MAIDW COST 0y COMRUC°.1 1:1103
9.42, ..,W
�' 1 5°b `7Ctt; 4tY 9 BY
CONSTRUCTION Fn 101-000-418-000 V90.09
PLAIN i.fi.1,E'G7191 P001 1014=439-318 $165.39
MECHANICAL L F99 101 -cif 0.421.4301 $6630
FL1,&L:TRIrA L. FFF, 101 -000-42CY-000 $144. $R
PLU:'ID1Nt01 E 1111~ 000419-010 $142.00
w'l ttT.1NC91o'1E3TION Fly � AZ5'tfJ 101-000-24-1-000- $1 ,30
(V A.r)1W(3 F Z K 101 •=0.0.42,9. 000 MAD
p �
u ►' c X°i1e13`It?i4,hWaPLAN (€IWf,240.6;
2001 8 PRE -PAID FM
$0,00
2
JUN, �
Al I'1 IVI—IF' ,SEEN DUE NOS
A
CIINANCE
DIP,
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR,
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing Q�i .���
Insulation
/ _L(t?
• _
�
Underground Ducts
Ducts
Retum Air
Combustibn Air
Exhaust FansMal_
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O,
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath Drywall - Int. Lath
5��o
Final
=-d�Z5
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
_ _
Waste Lines V7
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
/•��� _pZ�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final �_/� _ Ogg—
LUtility
UtilityNotice (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)
9
E�
12!12!2002 THU 13:32 FAX
Z 012
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:
79-844 Dandelion Drive, Lot 27; Monticello -Heritage, La Qulnta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13
GENE L CON RACTOR: CENTURY CROWELL COMMUNITITES LICENSE #;71w_ff
BY: TITLE: os SG Y
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 832072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
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:
Occupancy Group;
SINGLE FAMILY DWELLING
R-3
79-844 DANDELION DRIVE
Type of Construction: VN
Owner of Building: CENTURY CROWELL COMM
Building Official
Bldg. Permit No.: 0106-354
Land Use Zone: RL
Address: 1535 S. D STREET, SUITE 200
City: SAN BERNARDINO, CA., 92408
By: GARY SHOWALTER
Date: 2/4/02
POST IN A CONSPICUOUS PLACE