9803-104 (SFD)H
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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
10/3i/99
VD ata � Signature of Contractor e� � 7
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.0 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.
()C) 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:
Cartier Policy No.
ZENITI"i 11.,%.;. CO. Z0420)i690'2
(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' compensajon visions of ection 3700 of the Labor
GAde�l a}I f th comply vQith fh' S�pr �ilion
vDate/ 3%�a� 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, indemnity
& 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 props. �f .,inspection purposes.
r �'
,Signature (Owner/Agent) f Date
f
BUILDINGPERMIT PERMIT# - CONTROL#p�
DATEVALUATION LOT 9893 -.104 TRACT 6
;:3 O,d3Ii..DO 3 c..g
JOB SITE
APN
ADDRESS
45-365 C1XRRI-E LAINE
I 604-37i-003
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CENTURY CROWELL COMMUNITIES
C".ENIURY CROWELL COMMUNITIES
1535 SL. "D" STREET, S[`E, 9200
1435 SO. "El" STREET, SCE. H200
SAN BERNARDINO CA 92408
SAN BERNARDINC) CA 92408
1909 81-6007 CIIL# 2120
USE OF PERMIT
PLAN -_AR - WD - DEL REY AT LA QUINTA NORTE
TRAC'r CONS'TRUC'TION 1,24 .00 SF
PORC'1-I/PXHO X00 SF
GARA00CARPORT 630.00 S ' '
(ESTIMATEDCOST OF CONSTIIRUC CION
811143I130
FIER1*111T FEE SUMMARY
PLAN CHECK:. FVE .101-000-435-318 $463.53
CONSTRUCTION FEE 101-000-418-000 $554.00
MECHANICAL FEE 101-000-4214)00 $47.00
ELECTRICAL FF•:E 101-000-420-000 SI(A-68
PLUMBING; FEE 101-000419-000 $118.06
S'rRONCt MOTION .FEE - .RESID 101-000-24t-000 $8.Oa
GRADING FEE 101-000- 42--000 $20,00
RORAS'IRUi: CURE F1'E 225-000-443-342.
i
F'� SUB=TOTAL CONSPRILIr-n:P4 AND PLAN CHECK
$3,11a.16
f - LESS PRE -PAID la l:.ii5
$0.00
JUL
TOTAL PERMIT FEES DUE NOW
X3,19 8.Y6
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
D SPECTMIM RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
SULDING
APPROVALS
MECHANN CAL APPROVALS
Set Backs
Forms & Footings
T1 '
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
p s-
Exhaust Fans
O.K. to Wrap
_ ¢jl
F.A.U.
Framing"
o —f y
Compressor
Insulation
--
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation_
Condensate Lines
Party Wall Firewall
Exterior Lath
O -ft
Drywall - Int. Lath
.Q
AI
Final
Final _. 4 q
OLOCKWALL APPROVALt
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
PLUMSWG APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
p —7— t
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECT=AL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fhdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Finao
Utility Notice (Perm)
COMMENTS:
Y v.
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, .CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/22/98
No. 17360
owner NameCentury Crowell Communities
No. 45-365'
City La Quinta
Tract #
APN # 604-375-003
Jurisdiction La Quinta
street Carne Lane
zip 92253
Lot # Square Footage
Type of Development Single Yamily KeSldence-
Comments
Permit #
Log #
Study Area
1,245
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
1.93 X 1,245 or $ 2,402.85 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 CC/Foothill Independent Bank/Ed Knight Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received' $2,402..85
/yam -)Check No. 604539
Signature ,/p�,�
NOTICE: Pursuant of A(dembly Bill 3D81 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approvatperiod In.which you may protest the fees or other payment identified
above will begin to nm from 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 authorized to
collect them on the District('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