0106-336 (SFD)M
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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
7141 U I WS 1/Z
Date Signature of Contractor""?
/ O r oz:_H ' ; s•- ✓r i
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 rovided 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 pt✓DEN Ky S 114 1,11 , Policy No. NjYry^JY48_(*
(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: d ,;:, Applicant—
,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties arA 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, indemnity
& 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) Y� - Date 1 -
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OUK-336 TRACT
$106,62.`1*70 3 24197.1
JOB SITE
ADDRESS
APN
7,-857 DAND10 t00 DRIVE
OWNER
CONTRACTOR/( / EN (NEER
t_rirNMY M, OWWC°O�Ai1ATWZ _
CF i1tY t',I�00U L COYM. iINME$
1,535 $0, "13" �"W11, M-7, 4.200
1535 so, OD" u` RIKEIIT. s .v. 0200
HAA7B1ANARM0 CA 92408
fqAWBRIMAR1? N0 OA. 92408
(Q►03)381.6007 C %, ?.17o,
USE OF PERMIT
pA7 py♦ y, To�1 [ P 7�`p♦y
f�7dY �.73.h.,f; d'�BIJJ.Ir:�l L+'W�^fw3.s7S71J'
SP"a) .11 LOT 3 P"N 21382. � PERMT .00ES 11tFt' M.CLiJOS? !3' AXK I' A1,,.t,
POOL O31.:DRIVi':'�Id'.t�Y APPROACH,
PUCT CONSTRUCTION 11300A 8F
110RCKMAT110 40.00 SY
GAMONCARVIORT 420,00 SF
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i?CMANICA.LFEB 101-000-4•21.-000 SSI},0p
2L? t:Y'£ XA1, ,ME 1.01-000-420-000
s. Y1ac . 101.000.419.000 5130.00
S'f'k1,ONO NO K N MfeE nMMID 101 -0004241 -COO S'.0.66
OR,.,&DINO Kv. 101.000-423.000 S 4,OU
T)3VEL0c,EH. IMPACT FY_?Z
b .M-T.AL co.T70n?X.MDWwPOT➢E.7.Ar**yj3Ckt=7ppAyqFyy
$3463.60
$0,00
; NOW 2 5 ?C01
CiTY OF LA OUINTA
FINANCE DEPT
r`
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION 7f7776ATE INSPECTOR OPERATION DATE INSPECTOR .`
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs _ Underground Ducts
Forms & Footings ?/� �o Ducts
Slab Grade _ Retum Air
Steel � Combustion Air
Roof Deck of �� Exhaust Fans
O.K. to Wrap q.` F-7 F.A.U. I c
Framing UL 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
Final
Final POOLS - SPAS
BLOCKWALL APPROVALS steel I .
Set Backs Electric Bond
Footings Main Drain
Bond'Beam Approval to Cover tti
Equipment Location
Underground Electric
Underground Plbg. Test j
Final Gas Piping 1
PLUMBING APPROVALS Gas Test
_ Electric Final
Waste Lines �� ���y� 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 a
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole i
Underground Conduit
Rough Wiring i
Low Voltage Wiring
Fixtures =
Main Service
Sub Panels
Exterior Receptacles
G.F.t.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
12/12/2002 THU 13:21 FAX
INSULATION CERTIFICATE
This is to certify that insulation has been Installed in conformance with the current energy
regulation, California Administrative Code, Tide 24, State of California, in the building located at:
79-867 Dandelion Drive, Lot 3, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLSpj
TYPE:BATTS MANUFACTURER: Certainteed Thickness: R-13
GENERACONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE #
By..
TITLE: /09.tl
PARAGON SCHMID BUILDING PRODUCTS, AMASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 1211212002
i5�
2003
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:
79-867 DANDELION DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:
Occupancy Group: R3/U1 Type of Construction: VN Land Use Zone:
0106-336
RL
Owner of Building: CENTURY CROWELL COMMUNITIES Address: 1535 SO. D STREET
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER
A� Date: JANUARY 25, 2002
Building Official
POST IN A CONSPICUOUS PLACE