9803-091 (SFD)U)
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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
11
11t1'1� �lU!'31/99
VDate 1ISignature of Contractor
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 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:
Cartier Policy No.
'LFN111'lI :NS, Co. Z042W, 902
(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
Co&e, I shall o tth comply w'th-th�,� provis+ons
Wate. � i 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
application. 2.
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 tE--
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 insp ction purposes. '
VSignature (Owner/Ager) Date • i 7'
BPERMIT# CONTROLk
BUILDING PERMIT
9x1)3��1
DATE VALUATION S9
LOT 71 TRACT AS 8 7
,69().6f)
1-7 a
JOB SITE
APN
ADDRESS 79-1,10 DUNE, DR -11K.
(AW06 -026
OWNER
CONTRACTOR/ DESIGNER /yENGINEER
C( yYURi
CRC)W.T.f.. .jVin'1i 7S
1535 SO. "D" S'1' EXE, WE 4200
1535 SO. !V S`TTitEE I-, 91F.,. 6.200
SAN BER.NARDINO CA 92,108
SAN BERNARD NO CA SY,'. k
(900,).18.1 -6007 CAL111 2120
USE OF PERMIT
�1J
PLAN 44 - SVD - MARMLLA A.1 1,A QUI NTA. NORME
TRAC'I'CON.S'iT21.1C:i'1,0N 1.,454.00 F
0ARAi3Ftfl' A1?U,°'ORT 661.00 5.f%
t! V'RMMM1) CO.�T 0.V f.`ONS 1'etT,;07ON
191. x90.60
111 i3 iff i?FI1<:SUMMARY
CON-MUr" TION FEB 1.01-000-418-M
PI, AN 01Ft X HF13 101 AM -4-10-319 $5013 ,
iLIMIVA'NICA:. F1X )W-000-•121-000 347MI
:V.11:C"I'ItXAL FEE S112A7
P1,LN4l3fN0Y FES 101-000-419-000 S f x.75
iii 1tt)i�t NAOT'(ON [ 1aF - R 07) 101.-000-241.-000 $9.17
c RADINC; I -EL 101,.000-42.1-000 $-20.00
INrRAWItt1a."I' IRE FEE 225-000-44:-342 Ii2,t}Cri.it4
,t
"TIP ;1
LIS PRE-F`AJD F—AEES
$0,00
'Q'f TAIG P141IR VI11, VEEN 011'UNOW
$3,487.49
RECEIPT-
DATE
BY
DATEFINALED
INSPECTOR
f.
r INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ Q
Return Air
Steel
Combustion Air
Roof Deck
r
Exhaust Fans
O.K. to Wrap
/f—
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
7 —ot-
Drywall - Int. Lath
— —
Final
_
Final 6 _
BLOCKWALL APPROVALS
P OLS - 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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
(�=1�_
Encapsulation
Gas Piping
Gas Test
=(
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP" ROVALS
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
t
1
F16iid _
Witty Notice (Perm).-
COMMENTS:
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, of 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: 79-110 DIANE DRIVE
Use Classification: - SFD Bldg. Permit No.: 9803-091
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 SO. "D" STREET, STE #200
14,
Building Official 0
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 10-28-98
POST IN A CONSPICUOUS PLACE
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