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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
e��C_ y 1U/3.1/99
at Signature of Contractor
OWNER -BUILDER DECLARATIO
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
i performance of the work for which this permit is issued.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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 I Policy No.
MITH INS. CO. Z042W902
(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' compensatio plrovisions of Section 3700 of the Labor
ede, I shal�or�,with complytO r -t ose p ov"sion .
V ateq ` i �' -t f Applicant `.
Warning: Failure to secure Workers' Compensat on 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 .
any permit issued as a result of this applicaton agrees to, & shall, indem fy
& 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
constFruction, and hereby authorize representatives of this City to enter upon
the above-mentionedpro �erty�or insp ctio purposes. �%
Zature (Owner/Agent). 4 Date'"► ' `7'�
PERMIT# CONTROL'#' -
BUILDING PERMIT
DATE VALUATIONLOT "03 089 TRACT
/I
I 1 �t� a A 5 -4 8661.
JOB SIT
APN .
ADDRESS
'T9-1,30 DIANC ORY VE,
iii? (1u50 -ii b
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CEMURY CROWELL COMMUNI'ITES
CENTURY CROWELL COMMUNITIES
1535 Sf i. "D" S'iREF 1', SIT. #200
1535 SO. "1D" S' MSFT, SIB. ,#200
SAN BERNARDINO CA 92408
SAN BERNARDINO CA. 92408
(909:}381-6007 CBLO 2120
USE OF PERMIT
c
'
PLAN 4BGR. - SrD - MARBfL%A AT LA QtTT N -TA NOR'TE
r ,
TRACT CONSI'RUC'TI[ON 2,477.00 S1±
PORCIUPATIO 36.00 Sr
GARAGVCARPORT 635.00 SI:
EST1MK1*ED COST O1+ CO1NS7`.RUC.".['1C71N
147,425.941
PERMIT FEE SUMMk RY
CONSTRUCTION Fh E 101.000-418-000 $$07.50
PLAN CRECK FFE 101.000-439-318 500.40
MECHANICAL FEE 101-000-121-000 $5.3,50
ELECTRICAL F.EF 101 -OW -420-000 $147.90
PLUMki.INO IFFS 10.1-000-.419-000 $170.75
STRONG MO TION FEE - RE SID 101-000-241-000 514,74
QRADINQ Fn 101-000423-000 520.00
MPRAIN'RUCTUR1 FEE 225-000-443-342 $3,306.31
ART IN PUBLIC PLACES - RESIC 701-000-255-000 $118.56
SUB -TOTAL CONS'TRUC710-N AND PLAN C.RECK
$5,_M9.66
LESS PRE -PAID CI1E
X0.00
�.
TOTAL PERMIT TEES DLII NOW
$5,309.66
RECEIPT
DATE
BY'%
DATE FINALED
INSPECTOR
t�
INSPECTION RECORD f
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�/ / (1
Q
Underground Ducts
Forms & Footings
J ' �j
Ducts
Slab Grade
-QR, 4-
Return Air
Steel
Combustion Air
Roof Deck
- q
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
?�- -
Compressor
Insulation
`
Vents
i
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
?
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
p—
-7- 2Z- ,p
Drywall - Int. Lath
!� F
= QJ.
Final
Final
��C.3 -QO (p(�
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
F4 ,P
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/_�Qa/
Pool Cover
Sewer Connection (3
Encapsulation
Gas Piping
Gas Test
_
_
i
Appliances
,
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
i
Exterior Receptacles
G.F.I.
f
Smoke Detectors
Temp: Use of Power
e,
Final
Utility Notice (Perm)
;z -
Certificate of Occupancy
City -of La'. Quinta
Building and Safety� Department
e,
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: 79-130 DIANE DRIVE
Use Classification: SFD Bldg. Permit No.: 9803-089
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM.
Building Official
Address: 1535 SO. "D" STREET, STE #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 11-13-98
POST IN A CONSPICUOUS PLACE
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 10/31/99
Date Signature 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.
ZENITH (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 shall forthwith comply with those provisions.
Date: 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.
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, indemnity
& 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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT# c
17 J4Qii VALUATION LOT M3489 TRACT
a Is s ■ 1 sywis S147,425-90 69 17899 —
JOB SITE
APN
ADDRESS
79-130 DIANE DRIVE
6044060-026
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENTURY CROWELL COMMUNITIES
CENTURY CROWELL COMMUNITIES
1333 SO. -D- STREET, STE. #200
1533 SO. -D- STREET, SIE. #200
SAN BERNARDINO CA 92408
SAN BERNARDINO CA 92408
(909)381-6007 CBL# 2120
USE OF PERMIT
PLAN 4BGR - ND - MARSELLA AT LA QU1NTA NORTE
TRACT CONSTRUCTION 2477.00 SF
PORCH/PATIO 36.00 SF
GARAGE/CARPORT 635.00 SF
ESTIMATED COST OF CONSTRUCTION
147,425.90
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101400418-000 $807.50
PLAN CHECK FEE 101-000-439-318 $670.40
'
MECHANICAL FEE 1014000-421-000 $53.50
ELECTRICAL FEE 101-000-420-000 $147.90
PLUMBING FEE 101-000-419-000 $170.75
STRONG MOTION FEE - RESID 101-000-241-000 $14.74
GRADING FEE 101-000-423-000 520.00
INFRASTRUCTURE FEE 225-000-443.342 $3,306.31
ART IN PUBLIC PLACES - RESIT 701-000-255-000 5118.56
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$5,309.66.
LESS PRE -PAID FEE
$0.00
TOTAL PERMIT FEES DUE NOW
55,309.66
RECEIPT
DATE
By
DATE FINALEO
INSPECTOR