0101-333 (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
478689 iJ:3f'41 Z /fir.
Date V 24- 1 ` Signature of Contractor,-�M-•--- ^^�^
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,properti- 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:
Carrier Policy No.
(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 3.700 of the Labor
Code, I. shall forthwith comply with those provisions.
Date: 1. Applicant •�'_ ^tea ::•
hti.
Warning: Failure to secure Workers' Compensation coverage;ls 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. N
IMPORTANT Application is hereby made to the Director. of Building and Safety
for a permit subject to the conditions and restrictions set forth on 'hist Pa
application.
1. Each person upon whose behalf this application is made & each, perso� .at
whose request and for whose benefit work is performed under or pursuAatiI io
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 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.
Signature (Owner/Agent),'r-" -' au Date ±L!
BUILDING PERMIT PERMITk
DATE VALUATION LOT �y��,-�) TRACT =
,�:4:rs3 8�dta.�3S3 :ia's _�3�tir int
JOB SITE
APN
ADDRESS
444 'IA C0T!, 0.KA1, .3C?
OWNER
CONTRACTOR / DESIGNER / EN INEER
Cifi3"rup' .:ANMUCAN isOMO:1?1v,LENT, Ca
M CENTURY A1tiM';'; AN' l;?k:VE WME1,r;, Col
55.487 20Tr-OHI MM -1 ��
55-497 f3OU111001.UILl
LA QT_TMi, CA 92253
LA (tri I 1,A CA 112253
(706-0)564-5612 C' SL,O ,'546'•1
USE OF PERMIT
y�g}1��ss,�/4qryry yy��1 gyp, �yq �p 4 �[�7
4T.I.TUClLE. FAC°.tiM .l��+LLV
t61
y� -, � � 16 P%�W 1 3N.P - PL'ln.l'd YY DQVS, 14(Y1 f.1.1uul)a� L.LO%'.K,
WA:t bS''C+OLAPA t' R,APPROA.CH DR VE -:WAY,
TRACT CON T RUCTION ZAt1 m sv
I?OnR0'x°IMATIO 46KOO SF
ti,ti'imCtiG1cAMR,r (�,wi 1,24,32%44
' � p��.�•&,q �� �{, �^ p�{� y p'q y{ �p �,gg �•i yp- pyr�•i/y{�
tl..�'4iET�J1, Wi' P iv Ol,'6A7.R!'n.6ir'NJLANM,a,'1T
y� ?�J/� $�¢¢��,, �jyyy�{��q�a�xyF�..f.,'6'.i.Ri1Rl.7,!aD
COAS`l'RUs:°'lION ?& 101-000-418.000 MLSD
P:tAw CH KC 9, 17'li': 101-000-439-.M $1682.30
tAECIMNICAL FRE 101 -000-421 -000 V1910D
V,,:C TRIC:A.1.l` I `E 101-000-420-000 D 3d. dL
PIt17A4I1b1�1C,ifi :<, 101sNO- 19.000
F�
s"'79'1tC��ykCia 7-io'f�rflt�i irF.'1!', s 1 psiv - o-.41-.000
Ac
p%i
j q1 q9
d��11:Rg.3Nr0t
�7.iL.1�J.J:d C1'�•,t.�t':7iefa �y�y %: tC ILIC •'�NS1�`P 6.4 "WV� .EA'A. Y4/
. Z.:lv
Yyi+ o ppte rr���� tNUnn �,a 1�s�1� 11 fv rc
Z.
`0'
cf�TR rf :�AY, 0C)INl.`RITO11014 AIR) CITEC"pK
p1Q'}��..A��•�'
RMS
y�)�.7{x�
TO y� AL PALWJR E:ESDUE HMV
d1J'X215.1a
RECEIPT
DATE I ]
BY
DATE FINALED
INSPECTOR
d-.
4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs _` _
Underground Ducts
Forms & Footings
�j 1 `A
C9
Ducts
Slab Grade
Return Air
Steel
100,
Combustion Air
Roof Deck
Exhaust Fans
_�'2-
O.K. to Wrap �
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
Final
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
2,\�3
Cdr
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
$
CdC
Pool Cover
Sewer Connection
er,
Encapsulation
Gas Piping
Gas Test
`I1'
Appliances
Final
COMMENTS:
Final
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.
Smoke Detectors
Temp. Use of Power
Final
'Utility
'`
Notice (Perm)
Certificate of
Occupancy
City of La Quinta.
Building and , Safety . Department'..r�� - ti°��
This Certificate issued pursuant to, the requirements of Section 109 of the Uniform Building Code,
certifying that, at the .6me of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use: For the following:
BUILDING ADDRESS: 44-355 VIA CORONADO
Use Classification: SFD Bldg. Permit No.: 0101-333
Occupancy Group: R 3' Type of Construction: VN Land Use Zone: RM
Owner of Building: CENTURY AMERICAN DEVELOPMENT, Address: 55-487 SOUTHERN HILLS
CORP.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 11-01-01
Building Official
POST IN A CONSPICUOUS PLACE
N