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LICENSED CONTRACTOR DECLARATION
I' hereby affirm under penalty of perjury that I am licensed under provisions of
4'tfiapter 9 (commencing with Section 7000) -of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
t License # Lic. Class Exp. Date
574127 A.
Date f 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
( ) I, as owner of the property, am exclusively contract nig 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.
(`mac);. 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:
Comer Policy NO.
S" CAI'.S F'UtdD
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) Icertify 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, JII shall forthwith comply with/those pr,.pvisions.
Date. h^ �Q' `� 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 purpose
ig' fJSnature (Owner/Agent) f .
BUILDING PERMIT PERMIT °°NTR°`#
5371
-
DATE f VALUATION s�i,ai4,t» LOT TRACT
i
JOB SITE APN
ADDRESS ° Q��jLsLr� Wi .JC1E J
OWNER
CONTRACTOR / DESIGNER / ENGINEER,
4�
Ei.i'1,�1131i'!'1. 4"t4 I I,LLN
S EV1 DODSON CON'S'111 C' 11014
45-200 bitil.D Ei1' WAS°-
>tMll COLLI TR CLU13 D.KfVE, 91E. F-4
L..^ QUrNTA CA 9215;3
PALM msi wr CA 92760
(1W)3-16-40-17CBLff 1044
USE OF PERMIT
L'CJ0 A,NO fii:'A �,)9i `1i ct 9
14.47>1.00 LS
�Q(u
.14,474.00
d.�CJ II�t6l�3 A,�CjE�r)', 174f E�'l.lF'ds`wfA?lf .
MAN CHECK t,%E ttl( 0(if3 ti�tj-else �:ir�S,3Q
e_10NS1FTt CT'!cit,1 FRE i 01-O(i4 •11. -1 ►(} $ € «.0t9
1411.;C',tlaWCA'LFEE --POOL 1.01-000-421-000
MC-0efaC:AL 00'-» P001L .161'-000-420-000 . $w5, o
.t%.LtlRAl31.NO FEE 'POOL lfli.-o0o.419-(?t)t� S'd't.fl0
k
tit '.Al, CONS �fi1,iCTIO'N J�1`fi) E'1:,A�14:'I�EL:.K
$363 �0
1987 LESS PRE -PAID ft -13
$0.00..
1
Or 1, !!'PRmff .Fli;Fs l3i:iE NtDit4'
363.30
all
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
6 OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
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 Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond 17
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
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)
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 Notim (Perm)
COMMENTS: �.
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4
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remove g�
,torepiace
,larger s¢e
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CITY OF LA QUIN TrA,
BUILDING & SAFETY DEPARTMEP,`-
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
't
AND ALL APPLICABLE CODES
l8 BY /Lb
I
,r
GENERAL SPECIFICATIONS
SIZE 15 X 30 1`
kREA 362 PERIMETER 82
)EPTH 3x5
-ILE CHOICE group 3 S , 54
t66. 12' of 6°
,OPING cantilever
)OOL CAPACITY 13.500 GALS
MOTOR HP STA RITE
HP1.5
MOTOR HP n/a
HP
FILTER STA RITE
300 SQ FT
FILTER RATE
103 GPM
HEATER LAARS SIZE
250 BTU
TURNOVER
2 HRS
GASLINE BY sdc
FT. 45
POOL LIGHT 400
CLOCK t104r
ELECTRICAL BY.
sdc FT.145
AUTO CLEANER
none
CHEM. FEEDER
none
PI ASTFR COI nR
White
DECK BY sdc SQ. 534 clr
STEP 10' FT.
SPA SPECS.
SIZE 7 RAISED +6"
revised LRE 1 WATTS 100
re ,
6-6-97
vised RI LEVEL SEATS 22" 24" 27" .
DAMWALL 6 " X 10 FT.
_ DESIGNER DAMWALL TOP
I randy SPILLWAY SIZE. 3 ° X 12 "W1
p
SPILLWAY OPEN CLOS
DATE # JETS 4 UPER LOW
5-30-97
Name: Elizabeth Steblien
Address: 45200 Bridgette Way
City La Quinta
TRACT Del Rey LOT#
• �' D son
PPALMoo S
fnflg POOPi� DESERT TEMECULA
73-011 COUNTRY .28910 RANCHO
Scale: 1/8"=1'0" CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. STE 206
NOTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA.
ARE SHOWN FOR ILLUSTRATION (619) 346-4032 92590
(909)676 -SWIM
ONLY AND ARE NOT INCLUDED. I s „ C7A I
m
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/19/96
No. 14604
Owner Name Century Crowell Communities
No. 45-200
City La Quinta
Tract # 25363-1
Type of Development
Comments
Street Bridgette Way
Lot # 14
Single Family Residence
APN # 604-342-007
Jurisdiction La Quinta
Permit #
zip 92253
Log #
Study Area 230
Square Footage 1663
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 1.84 X 1,663 or $3,059.92
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.
Fees Paid By Foothill Independent Bank -Topaz Telephone 360-7464
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,059.92
Check No. 28118
Signature ,e( A 11 4,. BUY 4 ALA
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