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9510-066 (SFD)r LICENSED'CONTRACTOR DECLARATION N 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with W Section 7000) of Division 3 of the Business and Professionals Code, and my oo O License is in full force and effect. +1.1473 rK13_ 1i31I36 r WW n License # 1 Lic. Class' Exp. Date N r• Date 14:1 j `K' Signatureof Contracttor , - - • -:.- ---..•T c" "4 CD H o> OWNER -BUILDER DECLARATION—, LLI IU G I hereby affirm that I am exempt from the Contractor's License Law for the following reason: I.- Z ( ) 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 LO Date Signature of Owner N 9O rn WORKER'S COMPENSATION DECLARATION CL Q I hereby affirm under penalty of perjury one of the following declarations: o g Z ( ) I have and will maintain a certificate of consent to self -insure for workers' LO H IO compensation, as provided for by Section 3700 of the Labor Code, for the X W W performance of the work for which this permit is issued. p J J () I have and will maintain workers' compensation insurance, as required by m Q U Section 3700 of the Labor Code, for the performance of the work for which this p U permit is issued. My workers' compensation insurance carrier & policy no. are: 4 Lo rn F Carrier Policy No. qT ? (This sectforbneeckn 5t I eldompleted if the permit valuatioNis fcrd$100.00 or less). co N cy() I certify that in the performance of the work for which this permit is issued, O I shall not employ any person in any manner so as to become subject to the g 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, 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 application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, its officers, agents and employees. f 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 1 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 buiidi'ng construction, and hereby authorize rr presentatives of this City to.enter upon the • above-mentioned property Tor I inspection purpose Sig nature (Owner/Agent) _....er• =_; ` _ . 1. A"' BUILDING PERMIT PERMIT�i���-f�6 DATE r91'lf1 "- VALUATION LOT 4A TRACT ZNF, L d JOB SITE ADDRESS 779-3-35, CAfL9111KO DEL ORO APN 604-1192.024 OWNER CONTRACTOR CF-,*NM>RV H0MF.%C.OMMrNMRS CS:-NTUR'Y. TIOWS COWN!". .1535 SOLT111 D =BF T #200 71-335 CA iNO DE1, ORO SAN CA 924011 S.AN BE NARDIN, CA. 92408 (90)3131-11007 CBL# 2120 -tS(in7 DESIGNEMNGINEER :FIRAW C0N7MYS eft A=CfATE la3G3yNaI iFi?iVlAP:I dpi"v 1`1`1 USE OFPERWTiAA: QTA,. ,J'J V Y .J4'1:L.1..1V� t C.ul AN��R. CA 926166 (01}91532-6978 RANGli0 OC:O'.I'ILIA) C� LA QUJN'1'A Nt)tt'1'E PIUSE M .K.AN 4 A FEE DESCRIPTION FEES P PJ Cr3;+:STRUCTION ELEt 'pI S" t3)'' 1WRASTRUC'rUKF,FEE O/ ' �` V e 'MACT CONS'1'.ttUCi'.IUN PORCWPAx'f0 OARAOF)CARPORT F.�S'iC1t AT1,,,D COST OF E.RMITF Fri. SUMMARY -AW C,'fT. CK FRE Me,. 101-000-418-000 WICHIOUNI :A, FIFIE M-000-421.000 I?JCAL ME 101-000-420-000 .tT143M101. FE lot -000 -419 -OW ONG MO IONI FlEE - RESM 100.000-241-000 MANG FU 101-000-423-000 225-000-443142 ART 1N 1aUM..f-C t'T,A(:T,d - RF—ST11 701-000-251-000 aid TOTAL CONTSM. UC 1,10N AND O .fO E.A_'L .PE,R1%1.JT z4 1995 q:O,.+,.N1011ri 2,43100 :3P .168.00 SF 590.00 S:t^ CONS'"1'RUC TIO11 $66415 $304.00 1y.t10 V60-56 S!,%.110 $14,61. $3,236.37 P±i.AN CHECIX LESS PRE -PIVD FEES �i�'MS DUR ASE.PTr ,: El RM p.F,ES 1,46,073.:20 $5,21.4.47 $0.00 S� ,2114.47 5,214.47 RECEIPT -DATE BY DATE RNALEO INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION - DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS . Set Backs Underground Ducts Forms & Footings Ducts Slab Grade 1A 7 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 Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I 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 Z' Utility Notice (Perm) COMMENTS: DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 110/23/951 Type of Permit I La Quinta No. 113793 Permit # Log Owner Name Century Homes No. 79335-- 'Stree_ t Camino Del Oro City La Quinta Zip 92253 Study Area 233 APN # 604-192-004 Tract # 124517 Lot # 0 Square Footage 12436 Type of Development Single Family Residence I No. of units 0 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 2 436 or $ 4,189.92 have been paid to D.S.U.S.D. for 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 Century Homes Telegi_hone 909-381-6007 Name on the check By Dolores A. Ballesteros Superintendent _ Fee collected /exempted by Pauline Pearson Payment Received Signature$4,189.92 Check No. 101138 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