9803-098 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
/ 714188 13 �-- ^— 10/31M
yDat� Signature of ContractoP`�
f
OWNER -BUILDER DECLARATION'S
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.
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 Policy No.
ZENI"1 4 043, CC;. 2042066902
(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 Sec ion 3700 of the Labor
Code, I hall forthwith comply with those -p. sons.
UDate' — pplicant
c --car
Warning: Failure to secure Workers' Compensatio coverage is unlawful and
shall subject an employer to criminal penalties an 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. P,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuanvo�
any permit issued as a result of this applicaton agrees to, & shall, indevIfy/
& hold harmless the City of La Quinta, its officers, agents and employees. G
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
thabove-mentioned propert inspection �rposes.
tSignature (Owner/Agee..,.- r Date �7
. BUILDING PERMIT PERMIT# CONTROL'#
DATE VALUATION LOT 9803-098 TRACT
78
JOB SITE
APN
ADDRESS .9-145 MANE, DME
604-060-026
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENTMY CROWELL CO IIN-lU1`dITIES
CENTURY CROLVELL COMM, CJNI t'.IES
1535 SO, ".D" STREET, M. #200
153; SO. "D° Si'REEE , STF. #200
SAN BERNARDINO CA. 92408
SAN BERNARDINO CA 92408
(909)38.1-600! C.tiL# 41i0
USE OF PERMIT
PIAN 4130k - S D - MA'RBELLA. AT LA. QUINTA NC)R.TE_ 751,. PLAN
CRFCK , UC—N0N .,.WP1AED
TRACT COidSMCICTIOON 2,477.00 SF
P0RC fVPATt.CS 36.06 ST` .
GARAG f' ARPORT 63:5.00 SF
ESTIMAYED COAST OF CONSTRUCTION
147,425.9113
t E1 Mff FEE SUIiIMARY
C014STRUC' IO14 .FFE 101-000-=418-000 $807.50
-
PLAN CHECK FEE, 101-000-439-318 S670.40
MECHANICAL FEE 101.-000-421-000 $53.50
M.ECTRICAL FEE 101-000-420-000 $147.90
PI.M INC; FE 101.000-4.19-000 $170.75
STRONG NIOTIONFEE -RESM 101000-241-000 $14.74
GRADING FEE 101-000-423-000 $20.09
INF Uil,$TR1UC'1`Ilfft.E FEE 22. 000-443-3 52 . $3,306.3,1
ART IN PUBLIC PI.A. FS - RESIC 701=000-2554M $118.55
PLAl4 HECK. FES 10:1-000-139-318 4502.80
i
r4
SUB -TOTAL COMMMfCTION AND PLAN CHECK
$5,3099.66
LESS RU. -PAID H&S
-1502.50
TOTAL PERMIT FEES DUE, INOW
1.44,806.86
r
r
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
�s
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
,BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
(Q
Return Air
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
.� 3 ,�
F.A.U.
Framing
^(d —
Compressor
Insulation
—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
—Z'
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
Final
Water Piping
�Heater
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 —2—
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) _ Z—
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
t
E
Final
LOU1 fy Notice (Perm)
t
10
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, 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: i 79-145 DIANE DRIVE
Use Classification:
Occupancy Group:
SFD Bldg. Permit No.:. 9803-098
R 3 Type of Construction: VN Land Use Zone: RL
t
Owner of Building: CENTURY CROWELL COMM.
�.,
Address: 1535 SO. "D" STREET, STE #200
A City: SAN BERNARDINO, CA 92408
Building Official
0- '"
By: STEVE TRAXEL
Date: 11-2-98
POST IN A CONSPICUOUS PLACE