9704-030 (SFD)LICENSED CONTRACTOR DECLARATION
U) 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
N W Professionals Code, and my License is in full force and effect.
O Z) M License #Lic. Class Exp.,Date
d �. �1 , _.- 0133
T
Z ir� /Date C Signature Of Contractor f '�
� 0
0 — % OWNER -BUILDER ECLAR TON
CD
Fw- W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
cL
(_ License Law for the following reason:
Z_ ( ) 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
+n
N Date Signature of Owner
ON
CL Q WORKER'S COMPENSATION DECLARATION
It z Cc I hereby affirm under penalty of perjury one of the following declarations:
Hp () 1 have and will maintain a certificate of consent to self -insure for workers'
X w LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ) I have and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
a: 0)H permit is issued. My workers' compensation insurance carrier & policy no. are:
1-t Z Carver ,tt�t,�� /l titt� CO,Policy No. ♦a r��
Cb � �s:,.tY 11,v INS. O
�p
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(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- t iat,,ifi (should become
3 subject to the workers' compensatio ,,provisions of ction 3700 of the -Labor'
Code all ,orthwlth comply with't Ose provi ions.
Date: / Applicant
r �y
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employe0o c minal 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
r
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 prop pecticn purposes.
/Signature (Owner/Agent)---"'Date
BUILDING PERMIT PERMI97"030 CDNT G3
VALUATION $S7,S,7V LOT. -52 TRACT �} j ,.I
DATE 4/7IJ,7! ;a�T
7?- Mi VICTORIA RIA �i�i VE
APN fDll� ���-�J�<S
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'NII.it Y CR(;3'lVELL C;ONIA.iC_d.1vtITES
w�
CRTI t"URY C}'.0'M-,LL COMM- NNl'# ES
1 35 S ,+D" 91,
1.535 so_ ori" 9 ClZEIi, ISTE. #200
SAN MNARDINO CA, 07.408
SAN ii):MNARDINO CA: 92408
f�(X�)3�il-ttxl7 C'BI.;1 2i"(1
USE OF PERMIT
S i) - P ill i f .lJ't`if 3 Nl.)'! !NCLi IA8 B LG+i; K WALLS Olt FOUL.
I)FI: REV, I>f,AN ,!XA, PLAN C -f a: K FEES €t4i'f3O( EI) KY '75% VOR
%:TCIE,'I` 3'I.r I:�S ;i3 taF' iAltiii$ VI AN `I'YPH.
I'tQa1�:T' 4'vI�I;;f i{.tiC C101J t,4€;%.i10 3F
l'U2trvEiA'i'.Cc� 3(i.Eki SYS
k'ir itAC'� sC r�1t[NaiY'! 413.011 S
' N'TrIMIt Fir, \iR+ \,fi♦:91 is I� M1iS/l �T.
t►7y�Vr,). 7�
11. AN #.;1A -K.%, I k I1 I (11-1 11- �3y - �! � A I..y E. f 4
l':ON114TPUKIi'f;ON I-11 is 1,01-000.418-000 sisi.50
NIVC'11,V41CAL FPX 10f. -NO -421 -OW . $47•.(9)
1I E;C1'IUCA.l,'FE8 141 00fl-4;x(1.000 510760
PL UMBINO F'06 E!0
s7'C? ?cxfv �'t`7t3N Fr:I RA -30-1) 141- -64 -(19)0 S9 719
CRt1DING FEE 1,()i (100-423 000 �Zil.Rt3
ilvFRAtii`Pt2tll.'TItICE FL13 2.25,000-443-34'4 Si.;90.1.1
�4rY1T r,N(, CON�'FRUC'1'dON AND MAN CHECK
$2,9'76,{}2
®®4
P�"1�® LESS -PAIDI.FEES
;So,wl
..
'IRsFAl., PERMIT h~h:%S i3UC INOMr.
52,976.0
APR 0 9 1997
.FECEIPT
DATE &4
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade 7
Return Air
Steel /
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap 7
F.A.U.
Framing 147
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
Encapsulation
Gas Piping 17
Gas Test
Appliances
Final
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) /of vllo
COMMENTS:
August 5, 1997 .
CENTURY HOMES .
Century-Crowell Communities
1535 South ":D" St. , Suite 200
-San. Bernardino, CA 92408
Attention: Mr. Mike Boggs
SUBJECT: STRUCTURAL .OBSERVATION FOR CERTAIN- PLANS OF DEL RAY AT
LA- QUINTA NORTE. LA QUI\TA, CALIFORNIA
Dear Mr. Boggs:
Based onyour request, and: the requirement pf the City of La Quints Buildins &Safety
Department , and per requirements of the Uniform Building Code (UBC), 1994 Edition, I
have conducted an inspection on the job site/Tract No. 261.88, Del Rey., at La Quinta Norte,
on
have.
July 30, 1997.
The inspection was limited to the lots Number 51 52, and 53 respectively. The purpose of
this inspection was to see if the structural requirements of these buildings were compiled
according to the relevant building codes and approved plans.and calculations. The
requirements include shear wall nailing, stntctural' connections.. and shear transfer details,,
strap, anchor bolt size, spacing and hold dons.
Some deficiencies were noted which were brought to your attention.
A follow up inspection of the site .was also conducted and previously observed. structural
deficiencies have been corrected to conform with the appr'ove'd plans and Specifications.
Please feel free to contact me if you have any concerns or questions regarding the above.
information. Once again, than!: you for giving me the opportunity to work with you.
Sincerely;
Z.and Assgciales
5175 Chapala Dr. Riverside, CA 92507 Tel: (909)784-2424 Fax: (909). 784-0706 , `�