9710-115 (SFD)' LICENSED CONTRACTOR DECLARATION
!.� 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
C14 W Professionals Code, and my License is in full force and effect.
ch Licerise # Lic. Class Exp. Date
r -Q-'
cZ Date Signature of Cont actok"
CO 0
J U CD OWNER -BUILDER DECLARATION
W d I hereby affirm under penalty of perjury that I am, exempt from,the Contractor's
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).
Cf) O I am exempt under Section B&P.C. for this. reason
1
N Date Signature of Owner
OCz
aWORKER'S COMPENSATION DECLARATION
Z
o I hereby affirm under penalty of perjury one of the, following declarations:
p O 1 have and will maintain,a certificate of consent to self -insure for workers'
X LU LL compensation, as � provided for by Section 3700 of 'the Labor Code, for the
mwj Q performance of the work for which this permit is issued.
Q I have and will maintain workers' compensation insurance, as. required by
Q U Q Section 3700 of the• Labor Code, for the performance of the work for which this
a: C0 f-- permit is issued. My workers' compensation insurance carrier & policy no. are:
'? z Carder Policy No.
65 4111.0r ;f r •1 � •.' .
. ry l..c.::r♦ �Y, r 1 -,.1, .t„r :l.Yi.N:1�,'c•.11.
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 stjt ll fo, �with comply with'Iiose-Bro ' io-
j�batel; 191 , 7 APPlicarft`�./'t�..
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 whosebehalf 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 Ciy, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the -above-mentioned proops"(,Inspe on p rposes.
Signature (Owner/Agenik -!:�, % Date
BUILDING PERMIT PERMITr coNTR°`
DATE J ,,.. VALUATION LOT TRACT i �!
;►;'s de�,,;1! it y:.Dt1 S [
JOB SITE
ADDRESS p;w i;
APN
60444 4A)03
)03
OWNER
CONTRACTOR / DESIGNER / ENGINEER
r'fA,. lx !} rt.,j ri"1' 1;1 ,
A �t .i1, -1 l..[ •,�I< 1. 1' Ji.l: 1
I''P1 Af'}'/ 1,�.1 }.' j"Clla ti`fl'1 1 Y''r i44%A5 Thri'1't *71:
1"11 ,J ♦ 1 �, 11• li• a� •illi!•�F L<.. 1....1
i_6,:5So. 'I"t" SiM7E1', i>11''. ti 200
1,_•,;�t3. "i,�M �Ziiisis i, �i`L,. J72ii,s
SAN FiVKNAJVANO i..'A WdiNi
5A_N IAl# tNAR1_-000 CA 9,74K14
USE OF PERMIT
ti' U
k ; l! •• M.A1tl�l ILLI.A PLAN ZSi X31 AW k�`tt4.h_"•K 1. 1.* t [QP -4 Q. . PXA..e t+ie;4:tLli.:LA )
itIAX17,f-ILL IzS1Y.41A 1i O '':rU1i1=, PLAN TYPE.
Fi Hi.}1A_ f 1„L„}tV:l'1'1 t.1,!�~'t'Tl./ly .'1,��.!J •V17 ,J7'
LI.d IiVlY D ;-11,1 Si 4�11 !� N.L,tI T1.1���- • 2"D '."11+7
�'l.•tfM.YYi
YuliS O i ? ){f
7�ruJ1/,.v.Y..»7
~;:(�NS'IV1.11'•[' 144 [ [;a. till-(K)n.-:pit;-U0 3��us.tr►
F�1.r11,Af i .1!?i °I.; •41:{'11; If11-fNx)-:9't+D_'t.�g �,t.3^.fi(r
iNINICA L E'Li. 4_1.1�100
t:i..C:�,'"t-tt14,A1: F'f�: •1la�i-C>i7i3-3Lii-(viii ��t:;Jl.iti
1'LIA1111NO
-,fo hlr vfy)N F I f - Idd slll tat
Gf ,UJINCt 17EC 101 f14a42349:0 � 5),t?ti
®®'3.
1 AID
'i t'iwA;,fifkiiC111 Rir:t[h 221-400-41-3•t2 s8��.tsli
ART IN 1'llBUC I'.l,.tt0_•:- . RESIC 701 4m-155 .040 $=7+1.tt(t
NOV .19 1997
4
OFLA VIUN 1
``f i('^i'(7?Akl.(Y)_i' f[i V['kIf'S'JOfJ; ,�';Q{
�-A,Sso7?
11)PI.AN01Wj41.,"41''k FT
.. Lf:i,ii Sli,.C-PA.11_� FTES':
�±
TO•!'.r' U PF64i' II;•kFS DOE NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
1
- - N-1,61011-41 y ..• �: ;I,!
_ 1.
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade —
Return Air
Steel
Combustion Air
Roof Deck _ g
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing _ 3 — 4 _
Compressor
Insulation - Q(
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath '(e - -
F
Final
Final —40,
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines Z. 3 7
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
.:r
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: 45-040 DEBBIE DRIVE
Use Classification: SFD Bldg. Permit No.: 9710-115
Occupancy Group: R 3 Type of Construction: VN Land Use, Zone:' RL
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Address: 1535 SO.."D" STREET, STE. #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 7-2-98