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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 W.l B d£1 1J2f
Date l -x< �`'�7 Signature of Contractor _-r.-f `��� f -J
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 constructthe project (Sec. 7044, Business & Professionals
Code).
O 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:
Carrier Policy No.
�0.1,�1i� �iA,Ci��; ik33, 1�►�i(C•�A�l1b.�•C+'s
(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: Applicant..-.
Warning:LFailurelto 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) 1�% + srr+ a +a� Date/•�?�?<:
BUILDING PERMIT PERMIT#
DATE VALUATION LOT0�Y :4 TRACT
$142,983= 29 :sr 197.1
JOB SITE
APN
ADDRESS
7"72 DdAE'W5)M ;i UIVE
604-4)72-W6
6
OWNER
CONTRACTOR / DESIGNER / EN INEER
t;Et?!'1)MY MOW U COM- . aSii .1ir[Es
(VEMI )RT MOWELL COMMUNUl M
1535 so, W, "KI1;'4IMMI, STr; #2W
3:53:) SO. T' VMWV, STT 0200
g'.P41 . ARD1170 CA 92�(D�
�J,�3!�':� ;'iY.t'�Z:Ua�.FO CA P214 9
(909)381.6007 MILO 2120
A
USE
(OyfF�PERMIT [ { ul y DW(f} jAyjy
SFD - LAOT 29 PLAN 41 - PER -PAI i' rJOES NOT MCi.i➢DE BLOCK WALL,
P001, OR DRIVYWAY .A1a,1'Ri,)t4CH, 74% KA34 4:HF, X IFFS REDUCTION
APPLIED FOR tPr.UI.°6'TPI , K,.AN WPM StUBMITTED.
TRACT CONSTI UCT IM 2,400.'.1'S STS
POlRCIl`€MATIO 62.011 sy
0ARA063la.AR.PORT 604,00 OF
CO1,ig1°RUCTION .F?E 103-000-418-000 S790,910I
PLAN wHWX FEE 101-M)-439-318 .. $165.28
1"H HAWICALy.ROF, 101-000-421.000 $66.3$
,t'z,FAt~'ti TICAL ME 101-000.4:0-000 $144.38
P14LIMB1NG R9 101.000K419,.DOO $di4�.plt
STRONO.Ti014 ^pi,� 101_01)0_241'.000
OPLADIh1O FER 101.000-423.000 Silt,�L�
L3ZViYWPY,% 11Vf1'A'<. r IMS $'1,!8f1l.4tt
AR
14'AND PLAN 05, ECK
$3,249.66
I - 1"Z k'IM.-PAID F
$0,00
rJAUUMA
RE EIPT _ _�_
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR.
BUILDING
-APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms 8 Footings
�J_ _
l _ �/� �r
Underground Ducts
Ducts
Slab Grade
Steel
Return Air
Combustfbn Air
Roof Deck 1-911M
r
d
Exhaust Fans
O.K. to Wrap
a� -
F.A.U.
Framing"
Compressor
Insulation
��l�b� - - -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
Final
Final
_
�, -// - dZ ��
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
Waste Lines
_
7/i�� /�
Electric Final
Heater Final
Water Piping
�
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer LateralJ
7
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Pool Cover
Sewer Connection
/ / !1Z
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
,c�•E waU L�
t� —mi :,,�
Final
Utility Notice (Gas)
��y;/62--- �� `6
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
Oz
Utility Notice (Perm)
f $�
12/12/2002 THU 13:33 FAX
(?1013
INSULATION CERTIFICATE
This Is to certify that InsLilaflon has been Installed In conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
79-872 Dandelion Drive, Lot 29, Montlicello4ioritage, La QuInta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE:BATTS MANUFACTURER: Certainteed Thickness: R-13
GENE L CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE #
B TITLE: 619&
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
<<<< MEMORY FULL >>>>
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
ollowing.
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
R-3
79-872 DANDELION DRIVE
Type of Construction: VN
Bldg. Permit No.:
Land Use Zone
0106-356
RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 S. D STREET, SUITE 200
Building Official
City: SAN BERNARDINO, CA., 92408
By: GARY SHOWALTER
Date: 2/4/02
POST IN A CONSPICUOUS PLACE