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LICENSED CONTRACTOR DECLARATION
_1 herebyaffirm 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
5 M127 A $131/97
Date -�'� �. Signature of Contractor µ'! I �
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, 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''istsNiP;Ayfwo'rkers' compensation insurance carrier'&`tpolliIcy 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 I should •become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code—,l shall,fortwith comply with thoS'pro islon
Date: !t - Applicant��••"
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
constructign'and hereby authorize representatives of this City to enter upon
the above_mention'.'d property for in pection purposes.
Signature (Owner/Agent) Date`%
A
BUILDING PERMIT PERMIT# CONTROL#
•
9611'•�0''43326
DATE lgNIS"6 VALUATION S45,000.04) LOT - TRACT
JOB SITE 71%.32.4) CAINUNO AMARILLO'
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CisKWItY 1,tJMIRIS
>"1'l 8 DODSt)N C_NSVK1KM0N
J, 535 SO. V S".l VXr' ..
Ci8ROi1� P CtI %Ria. tiG$
SAN BERN&DINO CA 9240R
C;:t1'Mi()1 AJ, CIIT CA 92234
r f »l1&t�i Qi
(610324.1.2:12 CB1.4 1044
USE OF PERMIT
f4 0L AN 010fk SPA
P001, KN 13 W& ONLY
1r;,'V'tN"J'ATEA) COST Co d:`ORNl'RIJQ.:TION
I y,f1Y110.i►i3
w'ka'lii.ii�l'I' I+'��I!�:itlJil'INIE1#ai°
Pt. A111 0 1'f CK F11
fti40,31AN!'C"•AL):r68--P00L 101.Ot)t1-=121-000 $2f,tlil
3;3X(,Tk1CAL i."TW. -0001, lot-l►(1t}4204VO S,�i5.f1Q
tal.f NtAll NO IF -- P001. 401-01(g)-419-000 $77.(N)
SUrVIVENL CQN9111(Jcxf10N ANDS PL N C'RECK
$363.30
' LESS FF:ER,
$0.00
�'A[, PERMIT MEN DUE NOW
536.9.38
;i �V AY,,,� �6
RECEIPT
DATE
BY
INALED
INSPECTOR
`DAT
�6
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 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 147
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
Final7 LMA
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
P.L.
Q
'+
POOL & SPA
' ��04 �� .. LIGHT SWITCHES
J��I 0 F ,� —5'- —►
a/c—
POOL - POOL
- EQUIP W
W
garage
door.
F
i�
l
. / I I
GM 13' BOBCAT
EM 18'
ACCESS
(remove &.
replace 2'
of wall &
W.I.gate)
CONTRACTOR cannot assume
responsibility for damage to
curbs, sidewalks, driveways;.
cement slabs, sewers,
lawns,trees, fences, retaining
walls, sprinklers, telephone lines
or shrubs. When access is made
through a neighbor's property it is
understood that you, the owner,
DATE have that neighbor's permission .
5-16-96 and assume full responsibility.
lot#50
Name -CENTURY HOMES
Addr wO9320 CAMINO AMARILLO
Citv:LA QUINTA, CA. „RANCHO
Tract. OCOTILLO".
Do soli
Poo s
SHOW ROOM
73011 COUNTRY CLUB DR.#F-4,
PALM DESERT, CA. 92260
PHONE (619) 346-4032
LIC # A-574127 jell lamb
SPA SPECS.
GENERAL.SPECMCAnONS
SIZE 7I)IA_23P X 42SQFT
SIZE 14' X 28' AREA 321
*4
RAISED NOT,,
DEPTH -3' TO -5' -3' r
LITE 100 WATTS
SHAPECUST PERIMETER 76
TRI LEVEL SEATS YES
TILE SIZE GROUP 3
22" 24" 27"
TILE COLOR MS -32 .
DAMWALL WIDTH 6" X 6'
RAISE BEAM NONE
SPILLWAY SIZE 12" X
COPING CANT. 88'
OPEN X CLOSED
POOL CAPACITY 10,920 GALS
PUMP CAPACITY '90 GPM
JETS.# 4
MOTOR HP STA MAX 2 HP 1.5
FILTER SYSTEM 3 300 SQ FT
FILTER RATE 100 GPM
TURNOVER 2,5 HRS
`�P...L.
RETURN LINES. YES "
i
MAIN DRAIN YES "
SKIMMER MODEL DUAL PORT
CHECK VALVE FOR SPA
HEATER LAARS SIZE 250,000 BTU
GASLINE BY S.D.G. 38'
POOL LIGHT -40OW
SPA LIGHT' 100W
CLOCK 24HR 220V "-'..
- - --
ELECTRIC BY` S.D.C. -133'-
ELECTRICAL BONDINGBY: S.D.C.
TILE AND COPING S.D.C.'
. / I I
GM 13' BOBCAT
EM 18'
ACCESS
(remove &.
replace 2'
of wall &
W.I.gate)
CONTRACTOR cannot assume
responsibility for damage to
curbs, sidewalks, driveways;.
cement slabs, sewers,
lawns,trees, fences, retaining
walls, sprinklers, telephone lines
or shrubs. When access is made
through a neighbor's property it is
understood that you, the owner,
DATE have that neighbor's permission .
5-16-96 and assume full responsibility.
lot#50
Name -CENTURY HOMES
Addr wO9320 CAMINO AMARILLO
Citv:LA QUINTA, CA. „RANCHO
Tract. OCOTILLO".
Do soli
Poo s
SHOW ROOM
73011 COUNTRY CLUB DR.#F-4,
PALM DESERT, CA. 92260
PHONE (619) 346-4032
LIC # A-574127 jell lamb
CITY OF LAS
BUILDING & SAFETY D EPARTMEN'.,
CONDITIONALU
ACCEPTED FOR DONSTROViON
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE 7E6S
DATE Fly
Notice:
Document Cannot Be Duplicated
Date 12/22/95
No. 13985
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Century Homes Communities
No 79-325 Street Camino Amarillo
City La Quinta
Tract # Lot #
Type of Development Single Family Residence
Comments
By
APN # 604-192-013
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 233
Square Footage 1804
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 1,804 or $3,102.88
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
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Ellen Patino
icSignature °'
Telephone 619-360;.7464
Payment Received $3,102.88
Check No. 0924
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