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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
r
71411388 :fs �0l31�2X
Date_ '+� ��_ Signature of Contractor ��j�'°�.���� r
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
li;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.
4( ,) 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.
.. (30M &I 4AME 11,30. NWO-1194063-01
(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. s
J) Date: Applicant ....Y"'1r"� i- r _4
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.
Sinature (Owner/Agent)).l .;�� E r Date/
••"'�—
BUILDING PERMIT PERMIT#
DATE VALUATION LOT lj�gtj • TRACT
Vg191-1
JOB SITE
ADDRESS
APN
79-05 •rry ON DR`gy}moo
60" 7 y /•yN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
�. s>�Y`7." P,Y CIR OW711 C(7ws-UNIIMM
C 1 CI. RY MC)WELL CfJMl+liC':WI1;` S
1535 80, V KKM,j,'3F.� 0-101D
1535 410, IV S'.ClR,('.�.,' _ 00TL, ON
SAW BER'KAR I O CA 92408
aM BERNAkL➢?.1 O CA. 92408
(909)381-6100'7 Ir1a.U, 2120
USE OF PERMIT
wF.0 .,1>.OT 1 PLA14 4PAR - Pfv"11T DOES '4+IDT'INC£,UDE Sk.00:kC'�1•,r' U,,
POOL C3RDRVIL�''b�A .aS.Y'P}%OACK g 1>z;Y► k�I�t 1i C I4 ;G° :. �, .�i15Y'� Y•'?F�
TRA.C,T C=13'TatUCTIt9'N ,>s5ff,ll0 dP
PORCH/PATIO 142,013 fir
+L"tteRAK?1MAT/tPO 6e44 0 3N'
CONSTRUCTION FTS 101.000418.000 $0;$91911
PI.KN CI.1aWK., IW1 1014K* -439-_ 318 86.40,1M.
WZRANICAL FeR 101-000.4211.000 $66.50
'r'1,XCTR1QJ%L, MIX 101.000••'.0-000 $153.33
F1.011Y HIND FFIR '101-000.419-000 $14,00
VR(7NO MOTION PEP,- RF3IV 107.000-2,41 -000 W."
OR -4 INO F`)``R 101.000-42 3-000 $24.00
53VV1110PER,IMP.A,CT NAV, $1,9fr"1.f o
Y:eE OYP0W 10Isi3ClilH�i•39n313 •:t,iO4.411
,�"1r0. , C403W IN (TION PTaR'fiK CHI�.M
.3ND
D l.EW 7'RF,�-IIAW FKYZ
42,500.00
J U N 2 5 2001',F _9 : MMY YKEUS DUE NOW
CITY OF LA OUINTA
FINANCE DEPT
$113120 3
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/
Underground Ducts
_
Forms & Footings
Slab Grade�0 �/�
Ducts
ReturnAir
Steel
Roof Deck
_
% %
Combustion Air
Exhaust Fans
O.K. to Wrap
Framing_ _ _
Insulation�61
0�
/
F.A.U.
Compressor
Vents
Fireplace P.L.�
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
vljm
Drywall -Int. Lath
I
Final
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
Gas Test
Electric Final
Waste Lines
�Kv
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
Gas Test
Appliances
Final
COMMENTS'
Final
_ (�
— °
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)
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12/12/2002 THU 13:20 FAX
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INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
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regulation, California Administrative Code, Title 24, State of California, in the building located at:
79.895 Dandelion Drive, Lot 1, Monticello -Heritage, La Qulnta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13
GENE L C N CTOR: CENTURY CROWELL COMMUNITITES LICENSE #�
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
Z 002
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TITLE: ADMINISTRATIVE ASSISTANT
DATE: 12/12/2002
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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
79-895 DANDELION DRIVE
R3/U1 Type of Construction: VN
Owner of Building: CENTURY CROWELL COMMUNITIES
Building Official
Bldg. Permit No.:
Land Use Zone:
0106-334
RL
Address: - 1535 SO. D STREET
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER
Date: JANUARY 25, 2002
POST IN A CONSPICUOUS PLACE