0106-335 (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
N W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
I,- Cy
LLJ
oZ -Date'';' Signature of Contractor
CDO� �. ._
J U c:, OWNER -BUILDER DECLARATION
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).LO ��
co ( ) I am exempt under Section B&P.C. for this reason
O N Date Signature of Owner
rn
d< WORKER'S COMPENSATION DECLARATION
C) z I hereby affirm under penalty of -perjury one of the following declarations:
0 () 1 have and will•maintain a certificate of consenVto self -insure for workers'
X W 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.
co Q C) ( ) I have and will maintain workers' compensation insurance, as required by
Q U0 Q Section 3700 of the Labor Code, for the performance of the work for which this
Il 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
CSD O .01403119 xN.S. AI i4�» sfr$ 11s
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,
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., -
yl
ate: Applicant
Applicant `�"1"i Ar'�".r d 1 .>``,•rJ
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. ,
Vq
Signature (Owner/Agent-)" //, � � +1 �� Datef/14�'-' C; /
BUILDING PERMIT PERMIT#
DATE VALUATION LOT Qj�w,'��a� TRACT
�$1.,'52,91020?.�d 19"1-'1
$
JOB SITE
_71
APN
ADDRESS
'P'9-8113.1. DAMP NITON �3R
MM-071fi G
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C '11MY GROWE€.L COMMMUM13
E:.' 3�.VRY CRCsWELL C0kt4hf 3nT TM
1535 80. °D" 97 -Mir s ITME. 42,4t?
1535 30. "0' O'Z°F.Ts1M M. 4200
14.ANMNAWN1r O to 92409
SAN BNARD.Lt90 CA 921,08
(909)381,,6017 C -`%L# 21 tl
USE OF PERMIT
y p� �yg �/ yy g 7 �pq�}
1ANGLIE 1.��I14Y�8.YJ•S. D 1�`4'�•�Awal7. G
�;M r 1.0T 3 PLAY 3B-PE1"c IT l".?iFls'S IdOT INCLUM BLOCK IVA.L4
POOL 01t DRt'V'9WAY .APPROACH.
TRACT CONS° RUC°!` 081 21215100 V
Pd:3at~"AIR0 a:.9.(to V
t"d&RA02MAR6'ORT 625.00 8F
FURM119w, (110s 0.1' CO.1`eFf.`Ri1'4:"�7fi1N
1321910.30
SI1bWXRy
CION I s RIItv""T1011 P71B 101-000-416-000 MUD
MP,1.q C1iL ...'1K 1 ffs 101.000.4.39-318 $600.46
M1'TIHANICALTSF.. loi-01,)04.11it-000 MOD
E1.,1XTRI.CAL FEE 101-000-4120-•+000 $1:39.53
WINGUE. 101-000-119-000 MUD
STRONG MQ710N FEE - 99S1D 101-000-2 4.1 -Li O $13.29
GRADMfi# RER 101-000.423.001 MAO
Z31',rMAJC?FER,M,PACT Mr, 00
D -`X ,1. '0 • , I :'t l t 1'i i Cf C
$4,638,28
IMS PRE -'AH) ME 3
SO Cfl
JUN 2 5 2001 ' x �� N DIEW I '
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Steel �L.�-
Return Air
Combustion Air
Roof Deck
O.K. to Wrap
_?� _��
! _
Exhaust Fans
F.A.U.
Framing
InsulationVents
_
Compressor
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
I
Final
p�
Final
� �rjp�.
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
�
/
Heater Final
Water Piping
_�
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1A /$ —ei
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
i✓ ��
/���F/�i
Utility Notice (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
_
Al&I-0/
Final
Utility Notice (Perm)
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:
79-881 Dandelion Drive, Lot 2, Monticello -Heritage, La QuInta, California
CEILINGS*
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENEW qOWARACTOR: CENTURY CROWELL COMMUNITIES LICENSE #7//
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, AMASCO COMPANY LICENSE # 632072
BY. 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: 79-881 DANDELION DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0106-335
Occupancy Group: R3/U1 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMMUNITIES
Building Official
Address:
1535 SO. D STREET
City:
SAN BERNARDINO, CA 92408
By:
GARY SHOWALTER
Date:
JANUARY 25, 2002
POST IN A CONSPICUOUS PLACE