9905-266 (AR)LICENSED CONTRACTOR DECLARATION
f'
L. re6y 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
4rofessionals Code, and my License is in full force and effect.
" License # Lic. Class Exp. Date
1.14188 B 11,131i191
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
Secf on 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.
GC i;:1�RtI tire. w�, ;fPJS: 14WC 544068-01
(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:.' 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
66r-rect.',l 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.
S' .nature (Owner%AAgent) Date
t� %
BUILDING PERMIT PERMIT#
DATE VALUATION pis s'iicsto LOT 97 Slt"°►-flyIHAiT 27899
JOB'SITE '' t ' APN
ADDRESS 79-1 it) KAVE COURT 604-371-005
OWNER CONTRACTOR / DESIGNER / ENGINEER
CE NIVURY CItO4'4!'E1_ L C;` �>t�MMJTnUS G� l'7"CtJttY C ilti4�'F.'i.rf� C()I�1R�LJI�l1'i"ti S .
1.535 sig. "u, STIt m., STS. 7#200 v%35so. 'v, "' "rp 1r:rr, �;t'E. !#200
SAN 148RNAM)INO CA � 24(yi'3 SAN BERNARU:iNO CA 9240es
(go,))� 1.0()07 C19L12120
USE OF PERMIT
:LOT 47 S-LTF J La E] i 1 AL TOP d' !fes ft i ••tl?33, C E�i+t� Fet2 `3'.i� c r t�7 Vii+!
16 l.N X) ,WX, 04ANWNU 243 3 • OF 0AR OF- INTO t3t.Yi�fJ`� ,R CrCi�R,
',.T..A.CT CON."ITR.UCTION 745SIG Sia'
a
PERMIT FEE ATMMA-fty.
CON.`d`ERK11Ota FE
101-000-48-000
ell toNCIRM ", TWIR
42g
:�iE`"tt/1ti;.LGl11:, I�
t(il;••f,300-c22 ! r0Jf3
:E-LE.C"1J CAI..1-M
101.-000420-000
PLU:M73:i4O FFIE
1011_000A194000
A1'R,0N � nib'? tON 1~FM3M
10! 000-241 -M)D
fNT.itiL�'�.t�,uc`1v(1L.El
22-5-000-443-542
SOL
AKI' IN PUAL(C rl LA.CEI- RESM 701-000-255-
$20.
SO
t6
68
85
28
tit!
,,LM-!CVTA1.C,ONS"�S�,UC .TON AND'PL,_A3 C;s-91?,t:;1:
LESS 1'RP.-FRslt ) F ES
TOTAI, VEHAITCkICES DUE NOW
RECEIPT I DATE I BY ' it' I I DATE FINALED I INSPECTOR
.284.47
$0.00
S284.47
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 4
Ducts
Slab Grade 1z
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
17
Final
Final
BLOCKWALL APPROVA S
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
COMMENTS:
_
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)
MAY, -13'99(T HU) 1043 CENTURY CROWELL COMMUNITIES TEL:909'381 0041 P. 001
FAX TIRANSMITAL
CENTURY HOES
CENTURY--CROWELL COMKJNITIES
Ca.Ufornials Favorite Hamebui.Icer!
1535 SOUTH D STREET
SAN BERNARDINO, CA 92408
(909) 381-6007 FAX (909) 381-0041
PAGE 1 OF 1
DATE: May 19 1999
TO: MR. GREG SUTLER
CITY OF LA QUINTA
FROM: MARTY HUTLER
PROJECT DEVELOPMENT
Century Crowell Communities
SUBJECT: 'LOT 97, TRACT 27899
PLEASE BE ADVISED THAT IAT 97 IS A PLAN 1 IN PHASE IV OF MARBELLA
AND IS PRESENTLY UNDER CONSTRUCITON.
THIS HOME IS BEING CHANGED TO A PLAN 1X I.E. A FINISHED BONUS ROOM
IN THE THRID CAR GARAGE AREA.
WE WILL NEED TO PAY SCHOOL AND PERMIT FEES FOR THE ADDITIONAL
LIVING SPACE.
r
COULD YOU PLEASE CALCULATE TH COST AND FAX TO ME AS SOON AS
POSSIBLE.
I AM ALSO BRINGING IN AN ARCHITECTURAL DETAIL OF THE BONUS ROOM
SLAB.
o p (:4v ctrl Vic) Gge 1,5 t tion
f -
Oy
MBB jE
/X
?&-
Notice:
Document Cannot Be Duplicated
Date 5/25/99
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 604-371-005
No. 18797 Jurisdiction La Quinta
Owner NameCentury Crowell Communities
No. 79-110 Street Kaye Court
City La Quinta zip 92253
Tract # - Lot #
Type of Development Single Family Residence
Comments
rtion to house during construction
Permit #
Log #
Study Area
Square Footage 245
No. of Units
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 245 or $ 472.85 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/Marty Butler Telep4one- (
Name on the check
411
By Dr. Doris Wilson •� ;,
Superintendent
Fee collected /exempted by Ellen Patino Payment Received $:4,72.85-; -I-
Check No. 636144
Signature
10TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
ollect 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
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REPETITIVE INFORMATIONyi!':.a'i;
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