9512-032 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 314473 8 1/31/96
License # Lic. Class Exp. Date
Date Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm 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, 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.
(This sectigr>An cfpgt g91cpmpleted if the permit valuatioquL loq%1,90.00 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 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.
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
""'
BUILDING PERMIT
PERMIT.,124132
DATE l 1VIV:)
VALUATION 30 .bfy.�3.3it
LOT JU
TRACT If
JOB SITE ADDRESS 79-324 CAMINO AMARILLO
APN 604-192-422
OWNER
CONTRACTOR
C1;NMi1RY,HOMES COMMUNMES
CENTURY LOCOS CIONI fiJlvr1 E's
1535 SOUTH D S'1'2M_ *#200
1535 SGUFH D SI.`R.:EET 11200
SAN BERNARDINO CA 92408
StNI BERNA12,D1M CA 92448
(909)381-c 007 CBUf 21::0
(909)381-6007
DESIGNER/ENG[NEER
FRANK GONZALES & ASSOC,
1334 AST CHAPM, OW AVE.
USE OF PERMI y Ur 'E FAMILY '. ,.. t Cir
Oil fA NOP. VA 0%,44 ! 7tri1{%rr_Rft
RANCHO OCUTITLLO !I .I.,A QU1N'I'A N'OX T1,; P' iASE X:
PLAN2CX
FEE DESCRIPTION
FEES
t'RACT CONSTRUCTION 1,917.00 SF
POir;.CHIPATIO 168.00 SF
GARAG ICARPORT 528.00 SF
/
ESTIMATE COST OF CONT. UCTION
11K,133.3
PERMI'1! >1!'EE SUMMARY
PLAN CHECK FEE 141-)W-439-318 $584.85
CONSTRUCTION FFM 101-M-41.3-000 $699.00
MECEiANICA;L FER 101-000-421-000 $55.50
,
ELT:C:TRTCAI- E11 101 -000 -420 -ON $140,74
PLUM-BING FES 10.1-ON419-OW $144.00
STONG MOTION FEL: - RES ID '100.000-241-000 $11 F
GRA1)I1+0FEE 101-W-423-000 52 00
INFRASTRUCTURE FE 225-000-443-342 S2,562.
AIT IN PUBLIC PLACES - REVE 701-000-255-000 $40.33
Si.)13.TOTAL CONSTRUCTION AND I -LAN CHECK
$4,258.76
LESS PRE -PAID FEES
$0.00
O
o D TALPER.Mff FUES D1f lE0NY
$4,2.7
JqV0B
1
99
RECEIPT
BY
DM�b
INSPECTOR
JAI
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 j1
Compressor
Insulation t,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
•
Exterior Lath
Drywall - Int. Lath 1,94
14
Final
Final
BLOCKWALL A PROVALS
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
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
LL
Final
Utility Notice (Perm)
COMMENTS:
`
Notice:
Document Cannot Be Duplicated
Date 12/22/95
No. 13976
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Century Homes Communities
No. 79-320
City La Quinta
Tract #
Type of Development
Comments
Street Camino Amarillo
Lot #
Single Family Residence
APN # 604-192-022
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 233
Square Footage 1907
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 1,907 or $ 3,280.04
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
Name on the check
By Dolores A. Ballesteros
Superintendent
Telephone 619-360-7464
Fee collected /exempted by Ellen Patino Payment Received $3,280.04
Check No. 0924
Signature
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