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9603-040, 9608-031 (SFD)U) H N t!) NW o ::) co r0ul W 01 Z TOr (D P:6 W W CD H D- U) Z co LO N ON U rn Q CL o2Z W ��O UJ LL 0 JJ m<U O � LO �Z_ ao n �O .Q 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. License # Lic. Class Exp. Date 714188 !1'-�/1-�% ]1)/31(:37 Date ST�r Signature of Contractor'-'Al/11-46 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). 7 () 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 . Policy No. uNiG itl4 irN�e.lRANC: � (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 •-��. � - � -� l ��dSex�..• 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 purposes. Signature (Owner/Agent) • BUILDING PERMIT PERMIT# CONTROL# 2922 DATE VALUATION ' LOT 9603.040 TRACT 3112.31% 51.46.629.60 4 23935-6 JOB SITE APN 33f� .ADDRESS 4S -a57-5 II.➢RtiERT AIR iY•ltB.VE 6ini•.331-002 'OWNER CONTRACTOR / DESIGNER / ENGINEER 035 50, "0' 5"i' L401', SN. 6200 1,535 80, "i3" 9.I1LfiFr, St`s. SAN BE'RN.,:1RDTN- CA, 92=1f}S; StIN BERNAltt INO CA 92408 (904)381-6007 (900)391-6007 COA 2120 USE OF PERMIT ' 1Y' 1' •F Q1' R A .f ..�.1::iM.��i.l�Yilt'4.f1!.bt�I1./1..}' T.._ _. _ ._ ...- _ _. . . KINIERSIDA, Cry 9n)25 T(YVA"L CM, LA. Q) .It TA.N(;'12.`M, PLAN Si11,119 4•.it,r1�,«I'i;c�;fJS':t�kIEC;`i'lt�N �:�f'y.tttl:3� ' 610 $111, 0ARJk0rYCARtsc 4tT 576.010 sp FSTIMAT ED COSVOPCO FRU NS' 1004 PERMIT itCC:+ll{l14M.NRY KANr!i CkFE(i SIMIIO kiCi'iANICA.1, P1X $79.00 3144.72 co alt I2ORIT4 <I vvIOf-tbti�- .141)1 $16 7.25 rx I'f rtA"1)TRIJIN FtZ i{8tifl 101,-00()-''241 9)0 $i.e— • titjtp3i:'I.i<d�i t'.I,%,d' ;i;t-{)lit!-Ads-uG�i �2Ci,t1t1 � tNFQA`fYl'R C'VORA Iq-.R � t4_.� 2 ^tCt.29 . Q Of . .2`e.gdl()U-i .'44 AR't* IN PI )MY" .lei'a:iCF",:i . ijffo-701 �000..2.5554100 m 4 •• .. �y /- N{'RCh7Q N1 spy SULOW Al. LANCIWCK LESS PRf -.f'AM F.FFS $0-00 }Ali 1'E10.111,7 9 EEE OVE NOW SSo3ll1.�S 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. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL. PPROVALS 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' APO ALS Gas Test Electric Final Waste Lines S 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: Notice: Document. Cannot Be Duplicated Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 3/12/96 APN # 604-331-002 No. 14223 Jurisdiction La Quinta Owner Name Century Homes Communities No. 453 5 Street Desert Air Dr. City La OUinta zip 92253 Tract # 23935-6 Permit .# Log # Study Area 228 Lot # 4 Square Footage 2477 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 1.72 x 2,477 or $ 4,260.44 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 Homes -Topaz Associates LP Telethone';;909-3816007 Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Payment Received $4,260.44 Signature azP 0 /UAA'6'-V� Check No. 102154 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 U) N U) T W Off('`) Q U) W O (0 1- O LL) w H d "u) Z 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' ic. Class Exp. D+t��I Date 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). ( ) 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 • 1,FNI' I4_fN;K Co" Policy No. 2042IA6ll)1 (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 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 (Owner/Agent) Date BUILDING P RMiT PERMITt�)�j1ji CONTROL# DATE .S'/ 8/96 - VALUATION , LOT 4 TR C3935-6 3844 JOB SITE -."1""' v'x"y°:''".: a-a�Fs I APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER t-;EP41'IU1111'Y C,1t0`%N1F1..'.. CMI MI,N1TIC-1 _ C;.N'MIRY CKOWELL COP.1MIJI'JMES 1�39,t.). 11.1_7 MEET. 611-1. 6200 333 S0. "El".,�U.irLl,91L 000 KAN f3t?.RNARDIN, CA 92408 SAN 13EkI`i', RDINO CA. a2408 * 909)?R 1-6007 C CIX 2120 USE OF PERMIT A4 i;;tr ELLANEO ., OF 3R: T 41t '1.*RA(;'I 4 5w",•5:,50F18f-,J f MR. ,j51.335 DIi3FR1` t+.P.Jq @'#+�I$1411T .Is':iW SUM rVIA:I Y kM•"fMAL• E:fJAiS'r€wI: n'ON AN'D :['l Art C;141iC K $U EI(l LESS PRE -PAID FIZE $0,00 RECEIPT DATE BY DATE FINALED INSPECTOR 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. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wali Firewall Exterior Lath Vywall - Int. Lath Final Final SLOCKWALL APPROVALS 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 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: 4