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LICENSED CONTRACTOR DECLARATION
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
Date61Signature of Contra n
' J
OWNER -BUILDER DECLARAT16N
f
) hereby affirm under penalty of perjury that I am.esiempt 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).
( ) 1, 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
Se ion 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 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 workerscompensat' ovisions of S Ltio 3700 of the Labor
C eAlhall fo comply ith thos v' ' nsat APPIiply
Warning: Failure to secure Workers' Compens o ..coverage is unlawful and
shall subject an employer to criminal penaltie 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 & eachperso, 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 ins ection purposes:
nature (Owner/Agen 'AA Date7711r<�
BUILDING PERMIT PERMI9NO3-adLI; -
DATE VALUATION
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APN ,
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OWNER
CONTRACTOR/DESIGNER/ENGINEER
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SAN RV,i INIARDIAiO ("A 92408
SAN f3r.R_iVARDINI CA. 9V109
+rAM.18I-r;f?rr7 CB!,'.' 2120
USE OF PERMIT
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IIJr:I)L!t.`F'l(JN APPLIED
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�,t°r+4trda7 Kf )TIClht a:, [.. lt.rrf;)l) tlal 0110-1414H'16 $11 619
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ART IN P'! 4111-W: PLACES
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RECEIPT'
DATE
BY
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set. Backs
Underground Ducts
Forms & Footings
r.3r
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
p — j;
Compressor
Insulation
_ $
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/ a
Drywall - Int. Lath
Final
Final
SLOCKWALL APPROV S
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment. Location
Underground Electric
Underground PI . 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
p - -127C
Encapsulation
Gas Piping
Gas Test/Z-
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) /Z 1.2 F
COMMENTS:
I
Desert Sands. Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/22/98
No. 17361
Owner NameCentury Crowell Communities
APN # 604-375-004
Jurisdiction La Quinta
No. 45-385 Street. Carrie Lane
City La Quinta zip 92253
Tract #
Lot #
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area
Square Footage 2,0.10
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 pursuantto Government Code 53080 in the amount of
1.93 X 2,010 or $ 3,879.30 the property listed above and thatbuilding
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By CC/Foothill.Independent Bank/Ed Knight Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Received $3,879:30
Check No. 604539
NOTICE: Pursuant of As#nbly Bill 3081 (CHAP 549, STATS. 1996) this wlll'serve to no* you that the 90-dey approval period in which you may protest the fees or other payment identified
above will begin to nm k1h the date on which the building or installation permit for this project Is assued or on which they are paid to the District(s) or to another public entity authorb to
collect them on the Diatrict(:s)(s`) behalf. whichever is earlier.
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