9803-085 (SFD)17
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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
714188 BC. _ 10/31199
VDate�– -'•�� ignature 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.
( f 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:
Carter Policy No.
ZENITTi; LNS, CO. 7(,12066902
(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 wit Aprlo
ose ovisS.
VDateA -,_%Applicant t�
Warning: Failure to secure Workers' CompensatioT'ccrve rage is unlawful and
shall subject an employer to criminal penalties and es up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if.
work is not commenced within 180 days from date of issuance of S c�
permit, or cessation of work for 180 days will subject permit to cancellation.
1 certify that I have read this application and state that the above information is
correct.�I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon_
the,above-mentioned property foinspection pSignature (Owner/Agent) _Date%- In
BUILDING PERMIT PERMIT# CONTAIX'?
DATE VALUATION LOT 98!%3 085 TRACT �$Lj$134,556.80 i9 v!
JOB SITE' f (pp v \ APN
ADDRESS 7.7-i0 DIANE iDRIN•E 604-060-426
OWNER 160 Ne/ 41 CONTRACTOR / DESIGNER / ENGINEER
CENTUI'.Y CRONVELL COMMUNITIES CEN71JRY CROWEII CO'MMUN ITIES
1535 SO. "D" STREF7, STE. 0-200 1535 SO. "D" S`ME'C, STE. #200
SAN BERNA.RDINO CA 92408 SAN BERNARDINO CA 92403
(909)381-6007 CBLi1 2120
USE OF PERMIT
PLAN 4A - SFD - MAtRBELLA &T LA ()iJiAl i'A NORTE
TRAGI' CONSTRUCTION 2,240.00 Si'
PORC'IIfPA712%05 SF
GARACiEICARPOR,1 635.00 SF
W1rIA ATED COSI' OF CONSTRUCTION
PERMIT FEE SUMMARY
CONSTRUCTION FEE
101-000-418-000
$762,
III, AN CHECK FEE
101-000-439-318
$631
MM3ANICA(. FFE
101-000-421-000
$53
ELECTRICAL FEE -
101-000-4.20-000
$139
P1,U 1V113IN0 FEE
101-000-/119-t100
$152
STRONG MOTION 1:EE - RESID
101-000-24.1-000
$13
ORAI).ING :RE
101-000-423-000
$20
IN-FRAa'1'ftirc:TURF.FEE
225-000-443-34?2
$3,016
ART IN PUBLIC PLACES - RPSI.0 701-000-255-000
$86
00
.50
.60
.75
<IG
.00
.76
'39
134,556.80
SLWrOTAL CONSTRUCTION AND PLAN CRECK 1,878, 75
LESS PILE -PAID FEES C.I1J
TOTAL PERAUT FEFS DUE NOW $4,975.75
RECEIPT I DATE ; I BY ` I DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-
Exhaust Fans
O. K. to Wrap
— —4
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
_
Final lo-aZ� '�
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines•
ap _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection B, V.
oZ —
Encapsulation
Gas Piping
Gas Test
cJ
Appliances
Final
Final _
Utility Notice (Gas) 62
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
,'Wain Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
aJtllity Notice (Perm)
COMMENTS:
Certificate of Occupancy
City of Ca 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
79-160 DIANE DRIVE
Bldg. Permit No.: 9803-085
Type of Construction: VN 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: 10-22-98
POST IN A CONSPICUOUS PLACE