9803-093 (SFD),. LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F— 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 ch License # Lic. Class Exp. Date
r-- C3 LO
i 7141 $ 10131199
oZ r� /Date 61 ' Signature of Contractor,/CD _ \
O 1�_
U C:) OWNER -BUILDER DECLARATION
HLU r— 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).
( ) I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
0)CL Q WORKER'S COMPENSATION DECLARATION
p M I hereby affirm- under penalty of perjury one of the following declarations:
Lo H O () 1 have`and will maintain a certificate of consent to self -insure for workers'
X W LL` compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ( I have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
Il 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
aD 5
C3 ZENITH Mls. Co. W42066902
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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I s,with comply witl�.tho aro ision, . L_
46ate. ' Applicant OA4
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 p&sonbati
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
above-mentioned proDertyjertnspectio, purposes. s�
jSlgnature (Owner/Agent) Dat
BUILDINGPERMIT PERMIT# CONTROL#
f
DATE VALUATION LOT "03-093 TRACT
5 5
5106,213.30 7.1 x, .
p
JOB SITE
APN
ADDRESS
79-090 DIANE UitiVF,
604-"0-0'26
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENTURY CRONVEL: COM:'fUNITIES
CENTURY CROWELL COMIN- JMTIES
13535 SO. "Ll" STREET, VE. k200
1533 SO. "D" 81WE , ST -E. #200
SAN BERNTARDINO CA 92408
SAN BERNARDINO CA 92408
1(909)381-6007 C -AL;t 2120
USE OF PERMIT
Lai
PLAN 2CR - SI - NIARBELLA AT LA Q3HWA NORT& 7910 PLAN CKFCh.
REDUCTION APPLfED
TRACT CONSTRUCTION 1.803 X10 SP
GAP -W- ARPORT 424.00 SF
Mi TIMA'STLD COST OF C'ONSTRUC•WN
106,213.30
PERMIT FEE SUMMARY
CONS"1'RUC'1'.ION FEE 101-000-118-(200 S664.00
PLAN CHECK FEE 101-000-4391-3.18 $551.55
NtECHANICAL FEE 101-000-42 0-000 553.50
ELECTRICAL FEE 101-01(70420-0300 $120.09
PLUKMING FM1 10.1-000-4.19-000 $134. 5
S'TRON'G MOTION FEE - RESID 101-000-241-000 $10.62
00ADrNG FEE 101-000423-00 $20.00
1NFRA3TRUC `UR E F1:E 225-000-443-342 $Z3S9.80
ARTI IN PUBLIC PLACES - RESIC 701 -000 -255 -OM S20.00
PLAN CHECK FEE 101-000439-318 4413.88
A
"-TOTAL. CONSMUCHON.AND .PLAN CHECK
$3,%4.61
LESS PPJ-,P.A1D FEF
4413.88
TOTAL PE.R'MIT FIC ES DUE NONV
$3,550,73
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
— �( 4
Compressor
Insulation
` l ��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
B –
Drywall - Int. Lath
G
Final
Final
l0 - ✓ GS771
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
Pool Cover
Sewer Connection
—(Q — 4
Encapsulation
Gas Piping
_
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (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
UU14 Notice (Perm)
_
Certificate of Occupancy
City of La Quints
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: SFD
Occupancy Group: R 3
79-090 DIANE DRIVE
Bldg: Permit No.: 9803-093
Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 -SO. "D" STREET, STE #200
M.
Building Official
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 10-21-98
POST IN A CONSPICUOUS PLACE