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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. Dante
7141 81's " /''��.`'',iUf3a{'fir
f Date Signature of Contractor
OWNER -BUILDER DEC�yL+AF-tATIO
P ,e�`
I hereby affirm under penalty of perjury thatAlPa,: 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). 01
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the, project (Sec. 7044, Business & Professionals
Code).
O 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 ZEN,`, 11y�_ 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, a d agree that if.Fl should .become
subject to the workers' compensation provisions ofiSection 3700 of the Labor
Code, I shall forthwith comply with tho a"provisions
can
%Date: � Applit 14W � ���
.� .,.e r
Warning: Failu a to secure o�Zs' Compe ation coverage is unlawful and
shall subject an employer to iminal 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
- - �P, - - -
BUILDING PERMIT PERMIT# .. � °°NTR°`#
y�-�,xf►
3166
DATE 4 f4 VALUATIONS1J (N76'�.40 LOT 18 TRAIL TA3t+ # {
JOB SITE APN i a
ADDRESS �-120141#1lV�Li�',l�iC� WAY. '6i14-342- 11
OWNER
C NrIi Rl %CtC �Y�'EII.4..�,:1.Ji�l�'dt,J1`. E.1"E"
�� _ ++D" �� r, 9 r , 9200
6A1v REDMAi2.OW, CA 924018
t9i?9:± • J-()001
USE OF PERMIT
SINGLE, FAA41LY
G►L~i REY ik 'LA Qtl:t:MA NORTE
PLAN, MM-9-
O.ARAMC'ARKJRT
CONTRACTOR / DESIGNER / ENGINEER
CIENi.VRY i. RO S'4'1:7,L l„OtiY11i Ni.t.iES
SMV' HE.R'vIAR IWO CA. 92,109
(4ti9��Ei#.o�fitl7 C`d�I.,t1 2421)
2,010100 SF
3wi.00 SP
1~§°I'IMATED COST. OF C+aNS'i#eUCT1,0N
'P.ERMIT .FIE SUMMARY
P1j AN! Hr -P. K. T-1 ?
��1•IjOt)».1R9«���
�i�gf).!9
CONS'1'RrTC"`T1q:N' IUl
!0l-tlltU>�iIH Qt}o
�:i}0
MiXUANIC;AL RE,
101700 421-0W.
s'r<i t.04
t LE rRICAL-f EE..
01-000) g20.000
0,0
,"rror-x Afu(ION t�� ; RE'sID
to-1-wo-v1.f-000
111.68
ol2.A13lwjt- �vi'.(s
1.491 +i0e-d2'3v�J00
520.')u
fNFR,A% RLK.` 1.40,, F r;4s
225-000-44-4-342
$2,627.27
A+.7'f.TJ17lEFli,[C:l'f,iii,"A;.� i�}�frl %¢if,.(}(ji?-w. �f►t1t)
19,41,92
ID2 3.1996
APR .
RECEIPT DATE
A90 PLAN CHECK
LESS PRE.PArr')r- is
BY
INSPECTOR :
$0.00
I®
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap D
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 I W IPOOLS
BLOCKWALL A ROVALS
- 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 ALSGas
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
Gas Test
Appliances
Final
Final
Utility Notice (Gas) E
ELECTRICAL P ROVALS
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:
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 4/18/96
No. 14345
Owner Name Century Crowell Communities
No. 45120
City La Quinta
Tract # 25363-1
Street Bridgette Way
Lot # 18
Jurisdiction
APN # 604-342-011
La Quinta
Permit #
Log #
Zip 92253 Study Area 230
Square Footage 2010
Type of Development Single Family Residence No. of Units 1
Comments
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 2,010 or $ 3,457.20
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.
Fees Paid By cc/Foothill Independent Bank/Topas Associates T lcphone
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Payment Received $3,457.20
Check No. 24015
Signature L, Q 1 A&A
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