9803-087 (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 Divisiori 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
714188 B � 10131199
vDBA ' ! �- Signature of Contractor y
' � r
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.
2%N rfF•T INS. Co. 2042066M -
(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
Cotle, I shall forthwith comply wojh a provisions.
IZ
rDate Applicant
Warning: Failure to secure Workers' Compensatil 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 G
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 propertyfor inspection purposes.
4ignature (Owner/Agent) `^ - Date
7
BUILDING PERMIT
DATE/11
VALUATION LOT
'1 $130,040.2t)
JOB SITE t ' '
ADDRESS 74-150 DANE ORME
OWNER
PERMIT# CONTROL#
67 9803-087 TRACT
APN
►SYd ACh 8'9 :_f�''."
CONTRACTOR/DESIGNER/ENGINEER
C%7"JRY CP.0 WIEL L CO;~r1ML'NMES CEN , RY MONVELL COMMUNl'I'1I S
1535 SO. "13" STREET, M. iriuG 15 SO. 'V'STREET STE. 0200
SAN BERNi1RDINO CA 9240E SAN BERNA DfNO CA 92408
(909)381-6007 CBLP 2120
USE OF PERMIT
PLAN 3 -AR - SFt3 - I+MA DIELLA. AT L A. QUfN-TA NORTE.. 75% atiLAN
CHECK REDUCTION APPLIED
TRACT CONS i xtUCTIO.N Z166.00 SF
GARA.CIir/CARPORT 6-14.00 SF
SUB -TOTAL CONSTRUCTION AND PLAN CMC K
:m � LESS PR.B-PALO
RECEIPT I DATE
TOTAL P +fit 11T FEES DUE NOW
DATE FINALED . [INSPECTOR
1341,040.20
x'4,723.37
-$4f1W
$4,261.:28
s'+:SHMAX ED COSTOF zit+ CONSTRlJMON '
PERMIT. FEE SiiMM'iARY
CONSTRUCTION EE
101-000-4.18-000
$748.00
PLAN CHECK FEE
101-000-439-318
8616.13
MECHANICAL FEE
101-000-42.1-000
$5:1,50
ELECTRWAL FEE
_ '101-000-420-000
$136.99
.PLUNMING FEE
101-000-419-000
$134.75
STR.(YNG MOTION M, -
{'
RE -SID lU1-000-241-000
$13.00
C.i1 ADIN+.°.'FISE
101 -000 -423 -NO
$20.00
1NFR,.k8, I FWCTL Wi FEE
225.000.443-3412
$2,9.23.90
ART :IN PI.iLi.LIC PLACES - RESIC 701-000-2514)00
$75.10
:PLAN C IECK FEE
M 101-000-439-318
- 452.09
Yr
SUB -TOTAL CONSTRUCTION AND PLAN CMC K
:m � LESS PR.B-PALO
RECEIPT I DATE
TOTAL P +fit 11T FEES DUE NOW
DATE FINALED . [INSPECTOR
1341,040.20
x'4,723.37
-$4f1W
$4,261.:28
A'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backsq
Underground Ducts
Forms & Footings `s�I
Ducts
Slab Grade — -"—I Fl
Return Air
Steel
Combustion Air "
Roof Deck
Exhaust Fans
O.K. to Wrap _
F.A.U.
Framing —
Compressor
Insulation
Vents
Fireplace P.L,
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath — Q8
Drywall - Int. Lath
-t24404—
Final
Final ' Z
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Corer
Equipment Location
Underground Electric
,;:Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines S 9—>9 —
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 Tei 24
Appliances
Final
COMMENTS:
Final oe
We
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I. t
Smoke Detectors
Temp: Use of Power
_
�t� x
:final
linty Notice (Perm) .(
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:
Use Classification: -SFD
Occupancy Group: R 3
79-150 DIANE DRIVE
Bldg. Permit No.: 9803-087
Type of Construction: VN Land Use Zone: RL
Owner. of Building: CENTURY CROWELL COMM.
W
Building Official
Address: 1535 SO. "D" STREET STE #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 11-4-98
POST IN A CONSPICUOUS PLACE