9703-070 (RER)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
714,188
f -
Da te�� / / 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 oroffered 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.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.
(Q 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 Policy No.
w4MI INS. W.
(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
JCode, I;shall fo-rthwith comply with those provlslons„ �- ^^�~^
V Date:/2 1 Applicant;--� - -�
Warning: Failure to secure Workers' Compensation.coverage is unlawful and
shall subject an employer to criminal penaltles,and'civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set. forth' on his
application.
1. Each person upon whose behalf this application is made& each person at
whose request and for whose benefit work is performed under or pursuant.to
any permit'issued as a result of this applicaton agrees to, & shall, indemnify
I & hold harmless the City of La Quinta, its officers; agents and employees.
2. Any permit issued as a result of this application becomes null and void -if
work is not commenced within 180 days from date of issuance of ,such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representativees�.of-th s City to enterupon
the above-mentioned property forinspecti�`ptirposes.
Signature (Owner/Agent)" Date ,
PERMIT# CONTROL#
BUILDINGPERMIT 9703-070 4835
1� TRACT
DATE VALUATIONGD° 11 a5t�y OA0 LOT �k 2536;-1
JOB SITE S 9, „4 ... IJd.UL C.0 UXI
ADDRESS
APN
604-343-013
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Cfi.V'fUf Y l: f'%� '1 v1�J � 1i
Et;��:2I�J`�cc+$��,rrJ..,,�. Cy,IRIO��°1F±[;l.: CryC�N1&14u,t4!`�3.gS
�::tl'.f1\, �'y
1.533 «kI„ wl t. � .L7
1 3t ,JL✓. "LA �P,:°iy r� & int ��ry7
SikN f-. 4J,'RPl.F>iR1_YfN0 CA 924L*
SANN CSKKNE113DINO CA 92408
(190)38 J -6007.. CB1 X' 2120
USE OF PERMIT
i.'O2vL lNt7.'' :t NIft(3 t;At GA4iAIM- WO 432 &r, l; `N US ROONf
W'a OT,14' (i0aOM a3�.� �(•
N lA1r4�'.["3e Ct�S'jr OF ��3vs uC7C.ION
PLAN Cfl C k rf FH 101-000-439»311
CON,"3 2 Jr,"MO1V ,FEE. 01-11XI0-418-00) %135.00
41 t4,t;tlA£d,Cttt :[ F2 101 000-1?1-0014? 1:5 Jit►
-U11Cf 1t10N1, f k 3 101d00 4204M $26A2
S'r0l`G'.MTA1fJNEi :f2k?M tot-000-X11.000AVIML
WfRASI;it Ii iTP.. FEt? .=5-000-443-342 $ f
tuts IN pun1,Ic l>1,ik.I rus-nastc 101-000-,255-000
0
su.8 w. E, 6A3s"1`l2iTC. *N AwD rtmq cfa1sC;.f
%CI'S I�.RE-PA117 FEES
$0.00 .:
T(Vf A], PERMIT VF!,RS DUE NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framingompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
'
Exterior Lath
Drywall - Int. Lath
1 114
Final
Final
BLOCKWALL APPROVALS
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 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
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
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 4/11/97
No. 15421
APN # 604-343-013
Jurisdiction La Quinta
Owner Name Century Crowell Communities
No. 79235 Street Laurie Ct..
city La Quinta zip 92253
Permit #
Log #
Study Area 232
Tract # 25363-1 Lot # 32 Square Footage 332
Type of Development New Residential Addition
Comments
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:
Add. of Sq. Ft. to New Construction
.EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.84 X 332 or $ 610.88 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
r,
Fees Paid By Dennis Cunningham
t.:Telephone,
Name on the check it
♦� A r.+ F
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $610.88
Signature AaAA&,; PIA"x".1
Check No. 2212
NOTICE: 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
above will begin to run from the dale on which the building or installation permit for this project is sssuec 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
MAY 30 '97 03:43PM P.3i5
CENTURY HOMES
Century -Crowell Communities
SIGNATURE AUTHORIZATION
I hereby authorize Dennis Cunningh Century Homes to sign on my behalf
for permit purposes regarding my residence located at L A u AI V
This authorization is valid through M rA3 So' .194
Sincerely,
I
r
time .
y Address 77-.2:35- L Av9(1z (fbu Z--
Phone No.
III
1535 South "D" Street, Suite 200 - San Bernardino, CA 92408
(909) 381-6007 - FAX (909) 381-0041
MAY 30 '97 03:43PM
P.4/5
A U. RTMENT OF HOUSING AND URBAN DEVELOPMENT B. TYPt Ur t_tltigatww utv�an�n
`, AW.q Rf ''� tPLE COMP : , AMU 909188 VpM
FAX (909)884.0524
Serves the Arn&&W Dry VA 1�g65 BEET, SUITt x200
C me 011INGUL
0401 -97 -9926 -NW
4. NaTCACE IMS CASA M0:
RE: LOT -32 TRACT -25353-1
C. NOTE: This form is famished to 9i.you a statement of actual settlement costs. Mounts pail to and by the
settlement agent are shown. Item nuked "(p.o.c)' were paid outside rhe dosing: they are shown here
(a informational pmpom and are not induded In the totals.
D.
NAME OF BORROWER:
ADDRESS-
GUY SHAPTER
79-235 LAURIE COURT, LA QUINTA, CALIFORNIA 92253
E.
NAME OF SELLER:
TOPAZ ASSOCIATES, LP
1535 SOUTH "D" STREET, SUITE 200, SAN.BERNARDINO, CALIFORNIA 92408
ADDRESS:
F.
NAME OF LENDER:
BANK OF AMERICA
73-820 EL PASEO, PALM DESERT, CALIFORNIA 92260
ADDRESS;
G.
PROPERTY
LOCATION:
79-235 LAURIE COURT, LA QUINTA, CALIFORNIA 92253
H.
SETTLEMENT AGENT:
AMERICAN TITLE INSURANCE COMPANY
SETTLEMENT PLACE:
1465 SOUTH "D" STREET, SUITE 200 SAN BERNARDINO, CA 92408
I.
SETfLEMWr DATE
05/21/97
CERTIFICATION: The undersigned escrow holder certlfies,that<:trna.agd correct copies of
this settlement statement have been mailird:.or delivered: 3a-tzhe:Duyer(sj•.and seller(s)
named herein.
DATE ;•'•�•:-�=:CC1;?:;1JY
ESCROW NO: 0901 -97 -9926 -NW NANCY WAYSZ ESCROW OFFICER
E/T d Wd9b:EO L6, OE AHW