9605-056 (SFD)Cf)
H
N Cf)
r W
0 n
LO
A W T
1` W
nCC�
Z P,
TO�
(D IZ 0)
J U
WW
U)
Z
(Y)
L0
N
ON
U °)
C1.
Q
Z
Lo Q 0
LL
0 J J
mUU
O
� H
Z
65
O
Q
J
D
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
iilftr'►s a3 ii)i';9c�i
Date " ' r' ? 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, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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 ZEN1.111 WS, C0. Policy No. • 2042009 01
(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, I shall forthwith comply with those provisions.
Date: "f ,rr. Applicant,_ 5 ,
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 a{
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 pnd 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) , •- � r- ~�- ?Date =� *�
�+
i.
PERMIT# °°NTR°`#
BUILDING PERMIT r?4�13�-tf:4G
96 I.{1};{.,1 O
DATE 41181(* VALUATION .'�5 i►41,�� .i'I-i LOT TRA601
JOB SITE f�i*, � t� CAAtirr0 RcySADA
APN 604-1,91-01.1
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
t 'I?Pd'I'I'_IRY (::1`i;3W), 1, f_'f. MINIL)"NITIV!
(TWIlAty C:It,(l..rl'U. (1101NI TUNE'I IES
1335 SO, .1)",
SASV .1 LRNARDIN+ CA 92-1108
SAN REE NAk, AN() CA 4244
t 9 051418 1-f W
t WOI tS 1-0007 Cpil.it 217-0
1 R A NX G03 IZAIM ASAXrE
USE OF PERMIT
SdN( �%.ts' DWELLING
1336 FAS`t' CHAe)MAN AVE1NUh
Cl.') 02144L 4249AX41*11
k kl`404C31:?E;;t:?TI L O 01.A QUf N3.'A N('_'R 1T
Pf, q't.140AR
CONSi'RIN,110N 2.728AK0 8
PC. RCf IPAT1t) 46.9f) 51r
GAP,W, E/CAi3k't9f4T S9o,00 Sr.
1~:S rI.% ATIP f) ayc. f OF CONS I`R1JMiON
1%X41111, FERSUMMINISIRY
cY>N:1TtL1rrMt N.M-B 101-0011.418.0,10 Ft33.Elfr
,PLAN F43, 10.1-(1(0t0-439-313 $114).1;
A4I3CHANJCj%L I;'EW 101.060-421-000 us. so
F.ElE. 1101•-000-420-000 S155.'18
, TrfX413 NICIT1a')1CFER - RES113 101-0M2 x.1.000 $16.10
1.,1RAIA NO FIX 101-.000-4`23-1x)0 .. S120.06iNFRA,ff.RUCr't'4.tRF,1�
118 225-�0W-4/13.342 $3,593.12
ART fN Ni?MAC P!,.-VTS.- RES'!I; 701-000-255-000. $152.43
�t3r 'rC�TA2 CON` ►RR1: CTION AND PLAN CHECK
MJ47.71
LESS PR..-.FIALD FEES
S0.00
TOTAL* PERAUT VC, ES DUE NOW
S-4,747.71
MAY 14 1996
RECEIPT
DATE
BYp
DATE FINALED
INSPECTOR
4: 1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Z
Ducts
Slab Grade.
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
Y7
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
Final71
BLOCKW
IV Iv,
FLAPPR'OVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APR ALS
gig
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
44
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 Notice (Perm)
COMMENTS:
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/13/96
No. 14458
Owner Name Century Crowell Communities
APN # 604-191-011
Jurisdiction La Quinta
No. 79-350 Street Camino Rosada
City La Quinta zip 92253
Tract # Lot #
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area 232
Square Footage 2728
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 2,728 or $ 5,019.52
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.
J
Fees Paid By cc/Foothill Independent Bank/Century Crowell Teleiinone = 360-7464
ommunl lesName on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $5,019.52
n Check No. 515639
Signature .. Qnn�o� �i; �1A a A-�
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