9604-094 (SFD)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
Pr'6fessionals Code, and my License is in full force and effect.
License # Lic. Class + Exp. Date
714 le e- i i3ii97
`''' r° Signature of
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of per ury,tliat I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees withwages 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 +
() 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:
Cartier Policy No.
_jif'i(. tfd fi i ,l.
(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 agre6 that if I should become
41*
Subject to the workers' compensation provisGne6f,Section' 3700 of the.'Labor
Code, I shall forthwith comply with thpse'provisions.
Date: -' Applicant
Warning: Failure to secure Workers' ompensation coverage is unlawful and
shall subject an employer to,cnm nal 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:fo
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.daws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectiion purposes.
Signature (Owner/Agent) •i'� Date
rir v
PERMIT #• CONTROL #
BUILDING PERMIT 96(WO 4 180
DATE 9196 VALUATION $1,,015,247.00 LOT �� TRA_ f,36,1-1_ 1_ F'f 0
JOB SITE
ADDRESS 79-235 LAVRIE COURT
OWNER
CONTRACTOR / DESIGNER / ENGINEER
:if'1' IR Y, C".1;(3;1rPC.'t, (""O&MILINi' E!
UINI "URYCt:C7M-01 },, COMMUN11,1ES '
1536 Slc3. 'TYI MU1 1" -inixj
1533 $G, "1" S PR,EET SITF, 4200.
SAN 8EMNAR1. IN- CA 92408
SA. -N fi3E#t%i.P1.;i?:MNO CA 92408
t °► 3$1<C 17
'909)381.6007 CLAIR 2120
11.1 rV. uNtNi MART. LiVii AS SCC, -
USE OF PERMIT
liVCi . RAjvftLy' WFL.f INO
S4SV PAStiER0 AVY.
01H ,RRY :r1 LA. {xi tIRYA. Nt�R°CL: r
PLAN 5CK
�I�>~t.A.�:, r ica���a���raf: fc'.s•���ra �.� r�.vra �r
721.00
% j
trl�i�A01'lC'ttl2.(t+E:'E' SF
'37CIA�� ,Q) C1,10 oil �=�-INSTRll0,10IN
M.247.00 .
tit;. �•.a •t-.�C �7 n �,y T.roit,t a.
cons"n2urn"oty vim 103.000-113.000
thri'l aUANICAL 1101, 5V10.50
1AJ?CfRX-A.],-TUP
tzt,s NIFIiS?u4"tPIT' :103-iA041-9-000 $148.00
T,OW,1c%XY..Cf0,As:tUiDi-00042*41-= $10.52
CiRMN140 114A 1.014)0u-12_!�t}Dt3 S tl.tki
tff�€?A�c'f�:ttt�"4'i.�f< f.f+l; 225-W-44;3.342 SZ368.Etf .
O Rl' 1Epi P1 nPAQ T'f,Ai`t,`f' - 9, 111111' 701•000"-lM 1X►
Urf0-1IrA IfU10XhD?f�4�3M
i 0 S` "
f3b-t�.C3
. L'94%8 1'RE-PAID RES
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$0.00
APR 23 1996 VY- .0 1%MUT FIETV4 OVE'NO W
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
c OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 2XI
Ducts
Slab Grade rl(ol
Return Air
Steel
Combustion Air
Roof Deck d
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
POOLS -SPAS
BLOCKWALL A PROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OVALS
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 A PROVALS
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)
Notice:
Document Cannot Be Duplicated
Date 4/18/96
No: 14360
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Century Crowell Communities
No. 79235 Street Laurie Ct.
City La Quinta
Tract # 25363-1
APN # 604-343-013
I Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 230
Lot # 32 Square Footage 1678
Type of Development Single Family Residence No. of Units 1
Comments
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 1,678 or $2,886.16
the property listed above and that building permits and/or Certificates'cf Occupancy for
this square footage in this proposed project may now be issued. -~
Fees Paid By cc/Foothill Independent Bank/Topaz Associates T, Telephone y
Name on the check
By Dolores A. Ballesteros•
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2,886.16
Check No. 24015
Signature
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