0108-008 (SFD)U)
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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
Date /! Signature of Contractor,/,
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). C
( ) 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:
Carrier 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.^ rr
Date: �� �., Applicant _ F" `r :r °°i •- r a^' t f —
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.
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Signature (Owner/Agent) j - ' f Date`
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
JOB SITE r
APN
ADDRESS
79-942 DAKdMff ii: N D
(O"724M
OWNER
CONTRACTOR/DESIGNER/ENGINEER
IC.'S ?�1YA1:"s°C ;iit:t �V l t Rte" a�lfi d33+T!`1`
0-4- �1[EtY CROW AM, i"OMMi3MC.1,`IES
'1.535 so, -,TY sn' ' m, a '1x woo
1535 80, '"aX el1'iUMT,;Yr&. 01200
&AN'�.Y8MRN 1k40 CA. 92AOS
Sl+,•'� MNAPTXHO CA 92408
(909)581-aw 2120
USE OF PERMIT
W101. Y, i1",a;y
SM, MAN' 3GRov, I.4a'I'4• PE". IT 110-LVZ 1407 INC"I.f D15, B1,0C K
WALIA4 X0014 SVGA OR DIUVENAY APPROACH
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POItMP.c rio 29.00.7P
C'r:R.MORICAILPORT WIN sr
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1132,91 ,20
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gS,75&00
A t'.eAIZ CHECK ��+Cn .0 OX 101-000-1439-318 syr' 10.46
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p$6010DD
.i:iIAPIC J !KCAL 'A;. Y: t01 ^� 40-4 fail: -000 31133.51+
P1,.LlMMO F ).01-I.1Ci0.419.000 M24100
ST. :Ra'tio 9RfJ", 304 FEE . R&IM) 101 R000 -71A, 1-000 $13.23
•I:�RADfAFC PBX' 101-000423-000 $20.00
_
.03eVV,1i0PS w IMPACT FEE $f,at17.i10
+ ��,1►:�,3p6p��.yx���
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j i AUG — 3 2001
DATE
BY;
•
DATE FINALEDRECEIPT
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Q _ _ _ )
O ���
Underground Ducts
Forms & Footings
1
/
Ducts
Slab Grade
Return Air
Steel
Roof Deck
d�_j/�j�
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.'
Framing
c, V _
Compressor
Insulation
L< '� U
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
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
_ /�/ 'C
��`'�v[ `--'
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
— 7 _ A
Appliances
Final
COMMENTS:�3
Final
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Utility Notice (Gas)
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- ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough VViring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
OWU
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: 79-942 DANDELION DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R3 Type of Construction:
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
VN
Bldg. Permit No.: 0108-008
Land Use Zone: RL
Address: 1535 SOUTH "D" STREET
s
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER
Date: FEBRUARY 28, 2002