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9803-099 (SFD)F1 LICENSED CONTRACTOR DECLARATION d 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 71'1198" 13 - - 10131 x'93 bDa a Signature of Contraetor_ 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. XI 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. ZM 241711 11 , (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 pr 'singgs I S tion 3700 of the Labor OOodWsli�la ort 'th comply wit 1 R;prov'�ion� ate: // 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 whose request and for whose benefit work is performed under or pursLiatjt-to/ any permit issued as a result of this applicaton agrees to, & shall, in emnl & 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. LSgnature (Owner/Agenri Dat ' �T BUILDINGPERMIT PERMIT# CONTROL# DATE l VALUATION LOT' TRACTa A $1.30.040.20 r� 79. JOB SITE r APN ADDRESS 79-155 DI NE iii1,%vrra; 604.064-626 OWNER' CONTRACTOR /DESIGNER /ENGINEER rT. .MilY r3/VVE(A.COI nUNIP 1C-3. cairuR moynty, /o mm.kiEs 13..3 So. "U" a klcll;. T, STE. #200 133..5 SWID9 STREET, STR.#200 #200 SAN �fl�"'.l NAl MNO ;.. CA 92408 SAN BERNAlZD1' O CA 92408 (�W)381.-,RX17 , OIL # 21'20 USE OF PERMIT 8FD KAN 313 SIM 1 -LA A.T Lig QUINT NOR T u- 75% PLAN CMCK li),MCfTON A}APLW"O J '.ii'ACT CON'S Titl3+.'"al' ON ; I66M SIF QiEi€z ACaF//CAi�1�Ca C'I' 034.00 UP - 8':� Ir"Ii.. TAED L.ON,Y 1�+ '!,.'4 .k C+.►KiA C.�iNS 4Se'�`Y 4✓:19Y3'8N.*.be! 1J'?`!l�RA'11 T >. IC.s'J SUMMARY CONS'TI2UC f 0,N,0W. 101-000-418-000 $748.00 PLAN C14iIe-1k, rJEE 10;-1000-439-3W NWHANICAL rise 1©1-t?n0-�t21-t2;)0 $53.5 i=d:F,C` IRICAL FIM '101-000-420-000 $136.99 PLt:NIA-INGF'M • 1.01-000-419-U00 S.d3s.75 Rntowi wyno?3 n2c - u-sm 101-0110.241-0M $13,00 (IRM)1NG T"PI.1 161-000-4.23-000 22-0.(4) K Ctori*Ft-AS`1KUCVJItE f 13E. 725-M-•443-342 $21925,90 ART IN PUBLIC PL ACEs$ - RESIDE. 41:,AN t HU,Ca: FE, 0 � " �t1�-�nq�t�y-: ►1� ��r;�.ov 3 S! g-T(::trAt (IONSIRV7,110N ANT) PLAN Ct~iE.01K. 54,723.37 11~S% t�1�1 �Ptlil3.F�E5 446".Q), y+ci`t'Ai,r ,1<s Y'O lYLLl Y .1+' i9!.S DU�, NOW $4, 261-28 v ED RECEIPT ° DATE BY' DATE FINALEDINSPECTOR ,.:, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade — - Return Air Steel Combustion Air Roof Deck (p -oZ Exhaust Fans O.K. to Wrap �� Framing (p —Qd' F.A.U. 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 1 Final` Final POOLS - SPAS _ BLOCKWALL 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 (— Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ Pool Cover Sewer Connection �� `— Gas Piping Encapsulation Gas Test = y , Q , Appliances Final COMMENTS: Final _ Utility Notice (Gas) 7g f 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 Final 9 tfl" Notice (Perm) lm --=,Fd J� N 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: R3 79-155 DIANE DRIVE Type of Construction: VN Bldg. Permit No.: 9803-0.99 Land Use Zone: RL Owner of Building: CENTURY CROWELL COMM. Address: 1535 SO. "D" STREET, STE #200 City: SAN BERNARDINO, CA 92408 Building Official By: STEVE TRAXEL Date: 10-28-98 POST IN A CONSPICUOUS PLACE