9605-150 (SFD)U)
N LU
W
p M
(� Lo
W T
Z
CD O 0)
J U ca
W W
f— 0_
U)
Z
M
LO
N
ON
U °)
CL Q
d 2 Z
0 Ir
,FZO
0 J J
C0 <
O
�M�
Nt Z
ob Z)
�O
J
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. 1
License # Lic. Class r Exp. Date
/14198
Dated ' /�-, Signature of Contractor
OWNER-BUILDER-6ECLARATION�-''
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).
( ) 1, as owner of- the property„ am exclusively, contracting with licensed
contractors to construct the project (Sec. 704,4, -Business & Professionals
Code).
() I am exempt under Section B&P.C: for this reason
Date Signature, of Owner a.
WORKER'S COMPENSATION DECLARATION
I hereby affirm"under penalty of perjury one of.the following declarations:
() I have and will maintain ajcettificate 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:
Carver ZENITH W.S. t:0, • 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 California; and agree that if Ishould become
subject to the workers' compensation proVislons of Section 3700 oYthe Labor
Code,,Vshail forthwith comply with those p'Fovislons:,�,,*1��`:
Date^'��'-L 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
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 pu poses.,,•_,,.; f /f
Signature (Owner/Agent) -*" Date
• ,,;..,.4'444' �,..:::-..,. ,
BUILDING PERMIT
PERMIT # CONTROL #
3383
DATE VALUATION ST24,69140 LOT
1I IIt
; TRA Tqi -t1 J'JOB
SITE
ADDRESS 45-30,54Di�a'!I:>I�i�t �M S RE T
APN►04_33 _003
OWNER
CONTRACTOR / D1EESILG�NER /
�� t{7ry+ 4 c A A y1�i 1�e
:-J: ��. [+iiw i� i..ii i4�ri'�i. : le�rctiilili•.d ia�:
tENlGIINiEER t t� p!� t y
�(..+i+%� l4arCaY {.1�e WJ,',�a is CL.i,iti�+Ai.i.iJly T'r
i 535 ;�1.1, nlf �i1i�13Gi, `J :. 1 6t)l�
153 tiff. "/3" . i, �'.E. h200
SAN .BEiIiNARDIN, GA. 924()k
SAN MFUNA.KDINO CA. 924(8
(049?MI.6007
f 0!J'f3R1.- tPt)7 C13LA 71251
BE'NJ1%6kt11d AGUIL AR ASSOC. J.NC.
USE OF PERMIT
S:ji�Jtaf,�".
545*9 PASSER0 AAV1?.
KJ v It»u TU F, 7% V/50
'I'CYPAZ AT 1.-A. QOft01%. I`f0,RTE
`!RAt71'a.:°+;:ffJSVRVC"I.I(M 2t)r3atif► `ISS'
t.
►ACV+Rf".1/�?A't'tc0 t��.0±? 51�
576.{)0 ,S
J%!S 1L711 -A ED COS A 's.,i.l'' 1rd, NS ARUC MON
124}0140
P11ANQ11 p� J0!-011+1-4�?-�.a8
$ti�$•�1.
01,f>"rRUC'r10-;d FER 01.000-419-000
1
Wf.;HANICAL F'.E8 101-000-421-000
5;9100
a& IV,1CA;,. Fitt. 101.440-420-000
RLUNJI?NG R.KEx.01000.41;9-M
STOM. iN9MON i - RlriS110 1.01.000-2414-0100
$12.47
GtiAOM0 Fa. 1e1-000423-000
52+1.41
1Nla'klA9I'Wt 11JRF 1�i .i; '1754)00-44-1-142
$2,786. 70
AIT )W PUBLICA..CFS - RE'S)1!". 7171-ft)-255.0t1R
SLID M'Y!P,,L C:ONS`9"1d.1.X-110N i PLAN C:IOCK.
.IANl
LESS PRE—PAID FE 05;
zs
'1 ITAI. Y'EiiMR`'J' )HE" DUENOW
$0.00
54�,ltalf�.Z4 '
Jul'q Q
By.
RECEIPT
DATE—
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX 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
BLOCKWALL OVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground: lectric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPR VALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out C
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer ConnectionEncapsulation
l2i 4-
Pool Cover
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:
Notice:
Document Cannot Be Duplicated
Date 6/3/96
No. 14533
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE .
Owner Name Century Crowell Communities
No. 45305 Street Desert Air St.
City La Quinta
Tract # 23935-6 Lot # 3
Type of Development Single Family Residence
Comments
Jurisdiction
zip 92253
APN # 604-331-003
La Quinta
Permit #
Log #
Study Area 232
Square Footage 2073
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 2,073 or $ 3,814.32
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.
V, i
Fees Paid By Century Crowell Communities Telephone'
Name on the check -
\
By Dolores A. Ballesteros
4 , \
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,814.32
P_ 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