9605-148 (SFD)U)
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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
7,141118/ ,,r1.,34T,
13 / 1013
Date �",';°e�l 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
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 7.ktJ1731. iN8. CO. 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 Cal ifornia,_,and gree that if I should become
subject to th�workers'. compensation•p ovisions of Section 3700sof the Labor
Code, I shalltforth4th comply with those provisions.r--
Date:APPlicant�
Warning:: Failure to secure Workers' Compensation coverage Is unlawfu'I 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
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 inspection purposes.,.
Signature
BUILDING PERMIT
DATE VALUATION 'S117,164.60 LOT
JOB SITE 45-24.5 DESERT Al S'l�iilH,1.I
ADDRESS i"'
OWNER
i3N tlJt.Y C':2f3��rELi. Cfuli; ITUNrr'1C:
1535 1�0. "D" 91REFT, SFE. 11200
SAN 01tRIdAFt.DIM CA 92400
rt}��a 3ti 1
USE OF PERMIT
TOPAZ Ad' :1.A QUINT A. NOWYE
PLAN 4X4 Oft
PERMIT # CONTROL #
q"5448 3381
TRACT
�a935.6 AH41i
APN
604-331-005
CONTRACTOR/DESIGNER/ENGINEER
1535 SO. "Ll" S"! REE r, SME. 11200
SAN 13ERNA.itt)IN0 CA I2A09
(N)9)38t-6W7 CUP 71210
lJRIKJi.MN AQUI ,M. l ASSOC. INC.
5,154 PASNA03 AAW..
'.RAQI`f' (,t`) N1,T1'Kt K11`1'14")N 1.918.0) 8F
FORCHIPIXT10 68.(4) 131,
r.iARA(31:fGAM_ )RT 41811/) Sr
ES` IAIA'.F E:D WST OF CONSTRUCTION
0ERMIT FFE F, SUMMARY
PLANGRE'C`h 11'f
101-�)'Q3Q�t1f3
�?`tr,�
0111-AN.S'1'1r.LICTIGAN 1Prlyl
1014VO JiS-000
=1.50
+1riPWI-IANICtt1.fEN -
10:1-000-42i-000
$47.60
E% Et: t R1rAG F"Ec-
101.02111 -d:20 -(10U
$!,! x.99
I'? fiMF?R 1; :. • -.•
101,,4)()0-41n-0!00
31"O °3G F%XY I��.,i PIX - U.80'
1011-000-241-000
QkAVANO FaZ
101 -000,4234)00
$ 0.00
1NRtAS'['121:JT1JRUFHE
2'S000 -443-M2
$2,6.15.85
xM.'1 FN NIALI4:'i?f,,.,1+A?: S - WNW, 701-000-2M%41t?0
U2.91
RECEIPT
sufj;IA I, C? N-STitU r10N ANID.PLAN CHECK
K
L SS PRE-Pi#i..C3 FEES
JUN p 3' 19 ro riv ft, 1011 r FF E DU � OMI
96 -
DATE I BY I DATE FINALED I INSPECTOR
$4,321.52
$0.00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
q.Ducts
Slab Grade
Return Air
Steel
Combustion Air .
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation Y 4L -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath 92
Drywall - Int. Lath
Final
Final.
POOLS - SPAS
BLOCKWALL APPROVALS
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)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/3/96 APN #
No. 14531 Jurisdiction La Quinta
Owner Name Century Crowell Communities
No. 45-245 Street Desert Air St.
City La Quinta zip 92253
604-331-005
Permit #
Log #
Study Area 232
Tract# 23932-6 Lot # 1 Square Footage 1918
Type of Development Single Family Residence
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.84 x 1,918 or $ 3,529.12
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 Century Crowell Communities Telephone
Name on the check d
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,529.12
Check No. 103483/103523
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