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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
714188 B tiil31�99
XDate L -i 9Signature of Contra¢to " M J " t
OWNER -BUILDER DECL RATIO
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 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:
Cairier Policy No.
7EN1114 INS. "0. Z04206vS02
(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
Cofle, I shall forthwith comply wit -tho e provis ons'i'd
�
VDate:LApplicants 1f !• �T
r
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.
VSignature (Owner/Agent — Date'44 J ' - W,
"
BUILDINGPERMIT PERMITN CONTROL'#
9803-0� zt
DATE VALUATION LOT TRACT
. !
4/111G $134,556.€0 YI
JOB SITE►
APN
ADDRESS - 79-105 D ANE DRIVI~,
60"6"16'
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CEN" -.Y CROWELL COMMUNMES
CDMAY CROWELL 'CM &1UNIMES
1535 S(7. "I)" STRUT,I I—E. # 200
153; SO. "1)" STREET, SfE. #2010
SAN BERNARDINO CA 92403
SAN BERNARDINO CA 92408
(909)381-007 CBL# 2120
USE OF PERMIT
tF
PLAN 4A - SFD - NIARBELLA. A C LA IQUINTA. NOR.TE3 750,S PLAN CHECK
REt7UCTION APPLWD
T:1tAC r CONSTRUCT` ON 2,24ti-00 SF
PORC-1UPATIO 36.00 SF
GARA+31?/i;r1RPORT 635.00 SF
` Wire vitt) COST Oil+ "sMOr��rii1~Tc{'CION
x';. n .ills
PERMIT EEE SUMMARY '
CONSTRLICTIPN M 101-OW4.18-000 5762,00
PLA -14 CHECK FEE 101-000-439-318 5631.29
NiECH.WCALtFEE $53.50
ELECTRICAL FEE 101-000-420-000 $139.60
PLUNIBINU'FEE 1.01-000-4.19-000 $1517.5
STRONG .MOTION PU -121=StD 101-000-:24.1.000 $13.46
GRADING FEE 101-000-423-U00 SZt1.00
tivFRAS`1'I2U (IME FEB 22:1-000-443-312 53.016.76
ART IN PUIBLIC PLACI«a5 -REST 701-000-255-000 $86.39
PLAN CHECK FEFE ► 10,1-000-439-318 4473.116
SUB -TOTAL CONSTRUMON.t AND PLAN C.14ECA'
$4,575-75
LESS
4473.46
TOTAL PERMIT FEVY DUE NOW
$4,402,29
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
i�
If
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
J
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- fj
Exhaust Fans
O.K. to Wrap
- p- Q
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
"
Final
Final o ` G—:
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
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
(
Encapsulation
Gas Piping
Gas Test
d
Appliances
Final
Final _
Utility Notice (Gas) C�
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
C
E
Final
Utility Notice (Perm) - y
COMMENTS:
Certificate of Occupancy
City of La Quinta
Buildingand 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
79-105 DIANE DRIVE
Type of Construction: VN
Owner of Building: CENTURY CROWELL COMM.
Building Official
Bldg. Permit No.: 9803-094
Land Use Zone: RL
Address: 1535 SO. "D" STREET, STE #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 10-21-98
POST IN A CONSPICUOUS PLACE