9604-081 (SFD)izx
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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
'71.1IRE4.(11`lli4'i
;Date .%-
"' �• %' Signature of Contractor ��"i3
�lr'
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.0 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 i 'NjTff yK.S. C,<_' Policy No. 3CALt 66901
(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 Californ'la; And,agree that if I should become
1 subject to the workers' compensatio�nAprovisions;of Section 3700 of the Labor
Code, I shall fortpwith comply witted ose;provisions.
Date: ��� ApplicantrX='-°`
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 eectionpurposes.
ell
Signature (Owner/Agentl: r Date
BUILDINGPERMIT ' PERMIT" CONTROL#
94414.08111 3167
DATE VALUATION LOT. TRACT ,
4118/V6 14'#i.�lii;6!Jft l I t Y,'di';; • i
JOB SITE
APN
ADDRESS 4,%400 8RUXXATE WAN'
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1�F: kPF4 tI1V /1tFi'�itlf:f 1 .(It'tA'#/I TA�1'i'I F7�.,CA1'lY
♦.i,lv tl,.•1� f lJ5��.I fY {.rF rl-. ..�/1l�S?1111 1 i1.1
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SAN HERNA13IANI CA 924m
`AN M.-I7NA MNf;;.) C'A. 92409
�I:Ki 1iRt.i ?ilr
f409 -ORI -h007 Cts A; 2120
USE OF PERMIT
BF 141At13)1v AGUli AR ASSOC.
;.iNIOJUI. VANIIH,t DW1;i,I.1).NG
N459t'A;` RERO AVU
10VI-114SWE, CA 9«SfIK
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PLAN W4
'f'It.A.c."1't;c�tV:al'ItCit:"!'1t7hi 1,�If�I.tNf .tt^
.
P(.) CH(I'A.rl0 36.00 NF
GARA.GPJ01,tlfi.M. r(4' 413.00 Sr
E.10 MAT;EIIi Cfy it OF C01MMUCTIUYIN.
VA05,90
PERMIT FEF SUMMARY
VII.A'm c KC9, F�'f3 1(,)1-000w439%'418 VRr 16
CONI STRIJCTION FILM 110J.-OW41840) 55184.50
,ilit~CHANIC`,AL iFfx� 101-000-421-000 547.00
ELECTRICAL t"'W 101-000-420-W{1 $167.90
trt•1fm-Rfti(.IMP, $11800
S'I aNG M(TrION FEEZ-1•:Is.S10 101.000-.41141- 000 SP.79
IGPIADING FET,1.01"0010-42.3.000 $20.tr)
I1 A.S`i'It0r-" 1IRV MT 225-000-K1-142
�Fi11=►`( ii+fi L`0N'1,VI .�fC.�"%` ONI AND PI.M.1 0111? X
(� U LESS PRE-PAID.RES
PproTARMffL
50.00
P - PEFEES UE NOW
R 2 �5�b,
93, 1.16
RECEIPT
DATE 4
BY
DATA F ALED
INSPECTOR
0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPRO ALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
0.
Ducts
Stab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans `
OX to Wrap
O (
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
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
Gas Piping
PLUMBING AP , R VALS
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 Test
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)
COMMENTS:
t
L.1
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 m compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 45-100 BRIDGETTE WAY
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: H-3 Type of Construction: VN
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Bldg. Permit No.: 9604-081
Land Use Zone: R-3
Address: 1535 SO. D STREET, STE #200
City: SAN BERNARDINO, CA.; 92408
By: DANIEL P. CRAWFORD JR.
Date: 4/15/97
Notice:
Document Cannot Be Duplicated
Date 4/18/96
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN # 604-342-012
No. 14346 Jurisdiction La Quinta
Owner Name Century Crowell Communities
No. 45100 Street Bridgette Way
City La Quinta zip 92253
Tract # 25363-1 Lot # 19 Square Footage
Type of Development Single Family Residence
Comments
By
Permit #
Log #
Study Area 230
1461
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports,
covered patios/walkways, residential additions under 500 square feet, detached accessory structures or
replacement mobilehomes. It has been determined the above-named owner is exempt from paying
school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 X 1,461 or $ 2,512.92
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued. r
Fees Paid By cc/Foothill Independent Bank/Topaz Associates Telepligne
Name on the check ±
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received
Check No. 24015
Signature AA-6/0—
$2,512.92
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting