9803-097 (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
N M Professionals Code, and my License is in full force and effect.
O n M License # Lic. Class Exp. Date
r- Q U7
� W 7143 A 10131/99
Z1Date� /,. Signature of Cont
o O � r
r- _CD
J U CID OWNER -BUILDER DECLARATION
WWW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N 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).
co () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
CD
CJ Q 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.
(4 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:
Carrier Policy No.
Zi-sNI H INS. CO. 7,042WM0I
(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' compens tion OvisiO t ofSection 3700 of the Labor
Code I ghgjI rt0th comp) with t se r4vfsions�'
Date: / Applicant'-
17
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 pursuantto�
any permit issued as a result of this applicaton agrees to, &shall, inde�y�fiify
& hold harmless the City of La Quinta, its officers, agents and
empl6yees�
2. Any permit issued as a result of this application becomes null and void�t
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 inspectlon purposes. i
�>
Signature (Owner/Ag@n1i);i�/�3 Date—
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATIONLOT 98MV097 TRACT,
9
$14612-13.3077 >5
JOB SITE
APN
ADDRESS
79-135 DL4NE DRWE
6040+60-026
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENTURY CROWELL COMMUNITIES
CENTURY CROWELL COMMUNffIE'S
1535 SO. "D" STREET, STE, #''200
1535 SO. "D" STREET, 917E. #200
SAN BERNAR.DINO CA 924008
SAN BERNARllINO CA 92,408
(909)381.6007 CBL/# 2120
USE OF PERMIT
PLAN 2A - SFD - MARDFI A AT LA. CSL' M N ORTE- 75% PLAN CUFCR
REDUCTION APP.L IFD
TRACT CONSTRUCTION 1,803.00 SF
GARA.GIMARPORT 414.00 SF
1?,%T3M'XFU1 D COST OF CONST kMION
3046,`113.31!
PERMiT FEE 801 1AMRY
CONSPRUCTION VEE 101-000-118-000 3664.00
PLAN C ,1ECK FEE 101 -WO -439-318 $551.55
ry CHANICAL FRE 101-000-421-000 $53.50
ELECTRICAL FEE 101-OW420-000 $120,09
PLUSU31NO FIT: 1014.110 -4119 -OW $1.31, 75
STRONG MOTION FEE - RESID 101-000-241.-000 $10.62
GRADING FEE i0l-00Q-423-000 ; 320.00
INFRAS`1'RUCTURI-4! 223-000-4143-342 $23390)
ART IN PUBLIC PLACP,.S - RE,iII. 701-000-255.OW $20.00
AN CHECK F16 ' 161-000-439-318 -34:111
�P
1
SUB -TOTAL CONSTRUMON AND PLAN CHECK
53,964.61
LESS PRr-PAID FL1iti
45413,1,8
TOTAI 1'TERAti? FEES DILTE NOW
S3,550.73
i
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
INSPECTION RECORD
t
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS'
MECHANICAL APPROVALS
Set Backs
_
"
Underground Ducts
Forms & Footings
S
Ducts
Slab Grade
-(-
Return Air
Steel
A
Combustion Air
Roof Deck
(o oZ�_
Exhaust Fans
O.K. to Wrap
_
7-
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
D O
S
Finals
Final
POOLS - SPAS
B LOCKWALL
AP ROVALS
'
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
�_j=Q� _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure',
Shower Pans
O.K. for Finish Plaster
;
Sewer Lateral
Pool Cover
Sewer Connection=L
��Q �.
Encapsulation
y
Gas Piping
}'
Gas Test
Lp -
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
/j -
ELECTRICAL A ROVALS
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
X''.
' "
k final
tiiilfty, Notice
8 �•
, (Perm)
(o .•
Certificate of Occupancy
City of L -a 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: 79-135 DIANE DRIVE
Use Classification: SFD Bldg. Permit No.: 9803-097
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
y City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 10-28-98
`' POST IN A CONSPICUOUS PLACE