9605-065 (RPL)U)
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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
:► 6236 03 MW97
Date``1 eSignature 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:
( ) 1, 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 A4, d? M�iI iNrkers' compensation insurance oa 4 `&ttpolicy no. are:
,.
Carrier 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, and agree that if.l should become
_subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. '
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of -the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth -on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
. Signature 4Dwner/Agent) �1 ` • Date %« ' `-
BUILDING PERMIT PERMIT# CONTROL#
3316
316
DATE VALUATION si IA110.00 LOT TRACT
JOB SITE `.9 305 C.Ali� 1NO 1i 01 0M)
APN tiff- i S -USS
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JI&I 7S.E NDY C1'iUNDWELL
SUNRISE P0101. -S
70305 CAN41NO DU, ORO
UKHOKNI V,.
LA Q4JJ _ A CA 9.1253
PALM DrS3lit r CA 9222
(G1t�� fl�S52.1 C..Uft 1509
USE OF PERMIT
PCIi. CA.}`il)!!.A SPA.
PCK)L ONLY
-L•f
• I It V1J w. . •
"'11VIATED C 091' OF CONS'STRUC"C 0fN
il,. iD.f3ti
PLAN C`•fflX•X'f iilz 101'!1!1@ 43S'-31$ $9,8A0
!'wONS'TiiU!:".x 014 FM 101-000-418 -000 51144.00
K -IR .10.NiC.AL PEE -- P06L t0i.-000-42M A0 3111_00
R[Jy; I1RfCNL f1,rJ- s-- tea 4€">(. 101-i}t042009) $45.()00
P1,z ktEA(Nf3} :?:; --1 ? 9f. 1!)1:: ilitii-a11t3-13(itl • $27.00
W. a.- i"{ L ��'U f s"{'1? l Tt "T 10KAND l3 PLANCEl1 CK
13.li{)
LESS 1'it3z'-1°'A1D 140
1$0.00
.:TM,
MUM I•c MrES- nUC.NOW
S333.60
RECEIPT
DATE
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
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 Wail 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 APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out _i
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final17
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.L
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
C;>
P/L
nn
08* AL 8'EC iCATIONS
POOL SIZE 16430
POOL AREA - 522 SO. r f.
POOL PERIMETER q5 LINEAR FT.
DEPTH 3'6' TO 5'
COPING GANTILEVER
RO CHOICE GROUP II
. f.
POOL CAPACITY Ai'P. 10,000 GALS.
PUMP CAPACITY qO GPM
I
FL
I FILTER RATE 175 GPMI
RETURN LNE I IK
MAIN DRAIN ANTI VORTEX
SKIMMER MODEL DUAL f'OIZT
HEATER N/A BTL
GASLNE BY: N/A LENGTH FT.
LIGHTS -POOL 400 WT. SPA N/A
TIME CLOCK NTEKZMATIG 24 HR.
ELECTRIC BY: SUNK15E BONDING 51,'►�IRIS
POOL CLEANER N/A
CHLORINATOR N/A
DIVING BOARD N/A
LADDER N/A
SLIDE N/A
ROPE RINGS N/A
ACCESS - TRACTOR BOBGAT
CONCRETE. REMOVAL BY: NONE
RAISED BEAM -LENGTH N/A HEIGHT
SCALE 'C= 8- -DRAWING.
TF -E C-RUENIVEL - FAMILY
7q-305, GAMN6 ESL QRp
LA QLT FrA'
RAN(F10 OGOTLLo
-: X6191440-5521 .
SUNRISEFOOLS PALM, DESERT,: CA.
CALJF<MNN UC�E NO,. C53-556236.
Fp-APPROVED en
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Noti
Document Cannot Be Duplicated
Date 5/3/96
No. 14434
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Century Crowell Communities
No. 45020 Street Bridgette Way
City La Quinta
Tract # 25363-1
Type of Development
Comments
Lot # 2
Single Family Residence
APN # 604-311-002
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 232
Square Footage 1469
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 1,469 or $ 2,526.68
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/Century Crowell Telephone 909-381-6007
Ommum 1eSName on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2,526.68
Check No. 515344
Signature PAi u Q p M p P�j AAA p/
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