9604-079 (SFD)U)
U)
N W
O Z) <h
LU Lo
I, T
W
r- C
�0
(0 o�
W W (0
F d
U)
Z
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 /r Exp. Date
.,Date Signature of Contractor/%` Y• - J�
.
'//AT
�-..-
OWNER-BUILDER,DEC&RA ION
I hereby affirm under penalty of perjury that<f am exempt from the Contractor's
License Law for the following reason: F
( ) 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:
Carrier„ Policy No. 1k36 901
.T a�'2ild.lt iia. Gtr. 20
(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 agreelthat if I should become
subject to the workers' compensation -provisions yOPSection 3700 of the Labor
Code, I shall forth ith comply with those provisions.
Date: �/7 Applicant W ?
Warning: Failure to secure Workers• I pensation coverage is unlawful and
shall subject an employer to crimirgal 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 Quinti, 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, 186 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 insp�
ection purposes
Signature (Owner/Agent) � Date
- BUILDING PERMIT PERMIT# CONTROL#
9404409 3165
DATE VALUATION LOT TRACT
4! 1 ii1'.�Ci � 1."►f3�i,51! i '1 sNO- I
JOB SITE APN
ADDRESS 45-1441 Bit I0(; ,TFC 1YA1 i604 -342,W10
OWNER I CONTRACTOR/DESIGNER/ENGINEER
f-P..11MIR Y CD2OWELL C011V.INIONOT1Ll.
1533 SO, rb"".9FRWI, Kit h'200i.�; W. "re°' �>'i�rt `II �`iiw. #700
SAN 14HRNARDIN° CA 92,10 8AN f3F6+wNAKEYING CA 92408
19091-%k 1-6J)07 C }►'i;lr 21_2tl
USE OF PERMIT
SlNkll.iv i~.re til.i' OWELi, NC4
Et1ei. tti:: �' ti's+ LA.!�etnii{4°i',1� iJc,%11'1`1.
PLAN VII
41W PA.' SSMC AV K,
TRA,0' C.0NS'1(V%C"!'1VN 1,.145>F�it 8F
OAR AC,FiC,s PC01T 0S.0 Sf.'
I+,.S'Iti`tM,kF 1,ai .ST 01 i.�3i�iS tiC'i7.ON
90, 50
PF:RMIT MY SUMMARY
.
K kW CJ1.1FCK ME '
W l
C014.5IM:dCT10r4FLTC.,;
101.-000-41MOO
S591J,OG
MWHANK AL, FEE
1111-0042i-000.
E-GEf;."t'l2fCAL FEE
1O.i-txii? Za QCltl
$t # 1.7kT
PJ,J!'i4KJ1NC? 3 Ee~
t(►1- )l3 (fin
�� ti.Etf�
k ITING M0110,14 i'I E - -KE+SID
10.1-0%O 241-000
S9,09
ORAVINc :IEE
101-09("23-000
tNFRA51'itUC I'UR:E FM
225-000-443--342.
$2,04,546
1711' NISVIRUG'"3'IONT f= PLANC11-MCK
LESS PRE -.PAR) i'l`.E S
996 L, YE, R, MIT % t�.E'S' DU NOW .
1'
RECEIPT ? L`l�i�- DATE I BY I D&VFINAI1ED IINSPECTOR
S3.435.31
Su.®o
5:1,455.31
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROV LS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
„ Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali 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 Pibg. Test
Final
Gas Piping
PLUMBING APR VALS
Gas Test
Electric Final
Waste Lines a
Neater 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)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
E)derior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
.t
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. 14344
Owner Name Century Crowell Communities
No. 45140
City La Quinta
Tract # 25363-1
APN # 604-342-010
Jurisdiction La Quinta
Permit #
Street Bridgette Way Log #
Zip 92253 Study Area 230
Lot # 17 Square Footage 1445
Type of Development Single Family Residence
Comments
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 followingTeason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 x 1,445 or $ 2,485.40
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
Name on the check
By Dolores A. Ballesteros
Superintendent
. d
Telephone
j-
Fee collected /exempted by Pauline Pearson Payment Received $2,485.40
Q
Check No. 24015
Signature 6�b_AAJ, `�`� 9_Ak,&Wn/'
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