0112-078 (SFD)LII. tIVJtU UUIV 1 hHI: I Uri UCI.LI1hAI IU1141
1 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 k Lic. Class Exp. Date
478689 B 3/1/02
Date Signature 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.
( ) 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:
GOLDEN EAGLE Policy No. NWC 54701401
(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 with those provisions.
Date: 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 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 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) Date
BUILDING PERMIT ✓ PERM "
DATE VALUATION LOT 0112-078 TRACT
$163,721.10 61 23971-1
JOB SITEAPN
ADDRESS 78-425 VIA SEVII.LA 604-212-007
OWNER CONTRACTOR/DESIGNER/ENGINEER
CENTURY AMERICAN DEVELOPMENT, CO . CENTURY AMERICAN DEVELOPMENT, CO
78-520 VIASEVILLA 7 8-5 20 VIASEVILLA
LAQUINTA CA 92253. LAQUINTA CA 92253
(760)564.5612 CBL# 5487
USE OF PERMIT
SINGLE FAMILY DVnalING
SFD - LOT 61, PLAN 2C. PERMIT DOES NOT INCLUDE BLOCK WALLS,
POOL, SPA, OR DRIVEWAY APPROACH. 75% PLAN CHECK FEE
REDUCTION FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT CONSTRUCTION 2,769.00 SF
PORCH/PATIO '72.00 SF
GARAGVCARPORT 633.00 SF
-ESTIMATED COST OF CONSTRUCTION
163,721.10
PERMIT FEE SUhDAARY
CONSTRUCTION FEE
101-000-418-000
$863.50
PLAN CHECK FEE
101-000-439-318
$180.06
MECHANICAL FEE
101.000-421.000
$98.50
ELECTRICAL FEE
101-000-420-000
$143.08
PLUMBING FEE
101.000-419.000
$169.75
STRONG MOTION FEE - RESID
101-000-24.1-000
$16.37
ORADING FEE
101-000-423-000
$20.00
DEVELOPER IMPACT FEE
$1,907.00
SUB -TOTAL CONSTRUCTION AND PLAN CB CK $3,398.26
LESS PRE -PAID FEES 1 $0.00
TOTAL PERMU FEES DUE NOW I $3,398.26
RECEIPT DATE BY DATE FINALED INSPECTOR
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
•Date —� Signature of Contractor- 4
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. f�t�iiMreaso�
Date 2.1'' 42,. 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.
.,,1 ) I have and will maintain workers' compensation insurance, as required by
S`4ection 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 Poky 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 3700 of the Labor
Coded hall forthvyith comply with those'proyisipRS
Date: ` 1- dd.•4i' licant
"Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject ari ,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.
Y:
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. uporiphose 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 applicator agrees to, & shall, indemnify uL
& hold harmless the City of La Quinia, 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) - Date
BUILDING PERMIT PERMIT# ,
DATE VALUATION, LOT �� TRACT
, .�23971-1
A�5t3
1° e > j �13 , t
JOB SITE
ADDRESS- i lliA►i��aea� _
APN �.
Cuf3��E-2 4.Q?f27
OWNER "
CONTRACTOR/DESIGNER/EN (NEER
O :C 3i. Y:AiM h3d.CMMWEI C)M&WT; CORS.
IMiT[3`RYA.r+IE';��'°.14?d DT-Ov aopww, car,
LA QUW.Ai. CA. X1223
-QLWA CA 922S3
(760)�I�i —5612 M1,0. $487
USE OF PERMIT
.SFD rr't.�Ky 61,�J�9p�.���1�x+yi�2C.. 3.�
r-S2+IK3'�3'y7s�i£ty,�tl.;�11.Fwtt)f��ig
r'fafq~�;fi'lplitp�l`�CyplCyt+�G �Y,.�OCiK6.�T;AJ1
POOL, 59 A, bRD 9.✓.[i.i�tf E.y A d3i-C"FiO �Chl' l5% 1' 1.11-}N 0SYl�itwX FEE
R.1;'DUCTlO)j.. FOR 1'df'tl131i'L,L S'S Si3AN& OF t;!!UZ MAN TrPR
TRACT CONSTRUCTION 4769,00 8F
5 PORC a .sEiTIO 72.00 Sp
0ARAMCA.lv}'ORT 633,00 3F
F-91MAM COSIL' 0 -Ir C; .1viS.MiBi.~�ION
1631 al.10
CONI$TRUC:T1ON ISE 101.000-418-000 $963.50
laTPICIL"ICAL FRF 101.000.421.000 59$.50
V12f F M
PIA. RO-40 FEE 101. 00-41.9-000 $ido,7e
SiI Nt MOTtOYNFEE-RESIV. 1,02.000-2411-000 $26.37
lr41+J $20,00
1 Li 1 �Rk'9.t"�y4•'����fi1Lt?9
9i�T&�r1�,�,Y&DYN'Ci
:P +
i '9e -J. L3�, .dt�t.. CON.1.ffl�.4J i',R..�ONAWD i",i.rtU..tl i. 'Mt.
(�
F.+an
V=AL FK now
MAR 07 2002
IT
T
+Y
RECEIPT "
DATE
BY
DATE FINALED
INSPECTOR
n , .
,
P.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
_ f�
3 v �+
Underground Ducts
Ducts
Return Air
Steel
2
Combustion Air
Roof Deck
/,�- Z
Exhaust Fans
0. K. to Wrap
6 — 3 — Z
F.A.U.
Framing
Z
Compressor
Insulation
.8,�
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail 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
——Z
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans -
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
' 02
Pool Cover
Encapsulation
Gas Piping
_ _
Gas Test
��=� , 9 r✓ 5�
Appliances
Final
COMMENTS:
_
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring�� L,
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final `✓ - ?/
Utility Notice (Perm) 1 ��=—
6
Certificate of Occupancy � —
City of-La..Quinta
// g
�r
Building and Safety Department ofti
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding 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: 78-425 VIA SEVILLA
Use Classification: SINGLE FAMILY, DWELLING Bldg. Permit No.: 0112-078
Occupancy Group: R-3 Type of Construction: VN Larid'tUse Zone: RL
- -
Owner of: Building: CENTURY AMERICAN DEV. Address: .78-520 VIA SEVILLA
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 11-01-2002
Building Official
POST IN A CONSPICUOUS PLACE
9._