9710-134 (SFD)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
/ —, 3.rt'18's €3 A 1,oil ir9"r
VDate�irf /5ignature of Contractor _ � y
//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
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 worker' 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 sh 11 forthwith comply with those�Jisions/..�
JDate: r 1 ; '//"'Applicant ._-P2 ' irk �_ �� 7`w^•-
Warning: Failure �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 r
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
corredt. 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 inspec Ion p r oses.
qS gnature (Owner/Ag4u )'_' _ r Date �>�/ a � h
.t
w
PERMITp
CONT'RO L #,BUILDING PERMIT
j�1
LOT
DATE VALUATION ti�
310'247 .(g..goo
11't0 q
JOB SITE
ADDRESS/ % 0 1131piSM.l�T &�,€2Lwfi>T
�1T�S�
7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1:13:1 Sia. 11D" S rte't:r131, We, #200
15.35 3-0. or)" � r� t:�: �', Kit, #1200
SAS! BERN KOINo (14A W409
SAN B1 11NAi3IANO CA. 92AM
USE OF PERMIT
1 1�
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,TMLITED COST CONST, XTION
KNOW SUMAIARV
PLAN G:I1Y3CK FEI 101.000-4131)-318 SIVA5
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}si.`EC"`fIZICALit%.f- 10140tii142.000 S12t.tis
PL1,111MBINi3 FRE 10:1-W-419-000
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R.fA1 NO g6; 10 1-N-42 3,00e $210.00
id 'zC r1." s itf f% t hili 1'f f a 222 5-000-10-342.
.AR1' IN PUBLIC PL MMS - RNM,\ 701-000-2554*0
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®U 1 1997 `3'0TA C, .N1s'!d_ItIf f l!j':lf, A' 1)Vle, NOW W
&.11524.68
'RECEIPT
DATE
BY '
DATE FINALED
INSPECTOR
d
INSPECTION. RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR,
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
or
Ducts
Slab Grade
_
Return Air
Steel
IfCombustion
Air
Roof Deck
Exhaust Fans
O.K. to Wrap
;r- 9
F.A.U.
Framing
—/ (—
Compressor
Insulation
--y — Z-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
—?.V,
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
/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
er/
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
—
Utility Notice (Gas) zer
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
0-1.161ity Notice (Perm)
V.
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: 79-185 DESERT STREAM DRIVE
Use Classification: SFD Bldg. Permit No.: 9710-134
Occupancy Group: R 3 Type of Construction: VN Land Use Zone:
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
RL
Address: 1535 SO. "D" STREET STE. #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 6-15-98