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9710-133 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of y FN-- t 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 r` Cf LO iM311!) Z r- ✓/%1 797 �r Z r- Date Signature of Contr" acto s^•-� O U C:) OWNER -BUILDER DECLARATION HLU r- 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). c•') () I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner O N CA Q WORKER'S COMPENSATION DECLARATION p 2 Z I hereby affirm under penalty of perjury one of the following declarations: Lo cc r � O () 1 have and will maintain a certificate of consent to self insure for workers' X W �= compensation, as provided for by Section 3700 of the Labor Code, for the mJ Q performance of the work for which this permit is issued. Q U ( I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this L rn F- permit is issued. My workers' compensation insurance carrier & policy no. are: `d_ Z Cartier p ryr y { 1Policy No. / q` ob = C.F�l741 ,/. 11 d f i . Q 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 woikers' compensation laws of California, and agree that if I should become subject to the workers' compensation:. • �vision�s offSection 3700 of the Labor or Code/�I jsf 11 fgrthwith comply wit .th se provisions. VDate: ���� , Applicant 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 4 application. a 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 propertyrfor••Rspecti ;?urperses. ignature (Owner/Agent`) r /f -w DateA BUILDING PERMIT PERMIT# CONTROL# ti. •`f I DATE ` tr /t / C1 7 VALUATION e� LOT � CT 26-11.9 Q 1, V ( _T JOB DDRES ADDRESS i PN � f_ OWNER CONTRACTOR / DESIGNER / ENGINEER Y�A7t'ri'i iIy v r'�n�c ri:; r r x•tPnr Zr,:': I� r� err t Jjj y,­ r't S i S0. 110Y I i RE ur, Sm. #Zoa 6 [335 S4. "i:t" SIRE 9200 :SAN BERNAULDINQ (-'A 92408 SAN BERNikKOINQ CA 921f�; (:#t)+alZtil..Esiiii7 t�l3t. ?120 USE OF PERMIT '60,�> k NIl1k.'t'!! IX !S,%! %NCIB, OF SAME, 11.AN '1IA't'r 11Z,+V e SI f*Otiti;i•rVPA. j0 U74,0 SP, 4;r Flf[1#E;;F..Jt�All1"�Ji4:!' 41_1.Us� ti#� PCIRMIT FEE MJMMARY PLAN C"F<.X F fl.' : 101..W41109-318 $1211.72 CON Sf`rat!(r01 t �.i: ttl} t}1}f) 1R-titNt SSfi1"9) ,AECHIVIv11CIV. Ftp: 1,01 -0100-4211-000 14701 11*1,';RICr1.i, nail:: , • 101-000-420-t)W $10.%1 P1at!A IAH411 FEr 10I-004-11.10-000 S118.00 111111Z0,14(l, N10Vf}N _ 411. 00 S9.79 4. ClItADING FEY. IU x -(Y,?E)4D-,)©0 31.'.0" ,W iMri2R35T3tC1�"lirf�i:.i/ 225-000-4,13-342 I,rc < � t, r't � t�•r,t_rt.��'tt:� s ��� � 'r ,N <. rs;t �; $1, o 76112 �J #,r: ti� E'1:,rs•T'1�1I� CE:3.:� E t13.fJC 10 1�9� 'E'ta�•Ali, �I�;�><a�E�r I1't�.c�,,� I�EIlI:E�fca'�� �-x,rr7�.t;' Nov RECEIPT - = ` DATE : BY. DATE FINALED INSPECTOR kill a Eff 9 - INSPECTION RECORD 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 /–;21 Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath a k _ Final Final - Z-- 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 PLUMBING APPROVALS Waste Lines Water Piping Plumbing Top Out Shower Pans Sewer Lateral Sewer Connection 9T _ Final Utility Notice (Gas) yd — ELECTRICAL APPROVALS Temp. Power Pole F'rdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors 4 Temp. Use of Power A Notice Gas Piping ' Gas Test Electric Final Heater Final Plumbing Final Equipment Enclosure O.K. for Finish Plaster s Pool Cover Encapsulation - Final COMMENTS: IN 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: 79-165 DESERT STREAM DRIVE Use Classification: SFD Bldg. Permit No.: 9710-133 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL Owner of Building: CENTURY CROWELL COMMUNITIES - M� Building Official Address: 1535 SO. "D" STREET STE# 200 City: SAN BERNARDINO, CA 92408 By: STEVE TRAXEL Date: 6-22-98 POST IN A CONSPICUOUS PLACE