9603-041 (SFD)LICENSED CONTRACTOR DECLARATION
Cn I hereby affirm, under penalty of. perjury'that I ani'licensed under provisions of
I— Chapter 9• (commencing with Section 7000) of Division 3 of the' Business and .
N W Professionals Code; and my License is in full force and effect"`
C:) Z) cy License # Lic. Class Exp. Date
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�' Z r ' sDate 6�'A, '�Cf Signature of Contractora� h-
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'~ OWNER -BUILDER DECLARATION
W
W W I hereby affirm under penalty of-perjury.that I. am exempt from the Contractor's
U) . License Law for the following reason:
Z ( ) 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
s Code). - .•-•
co ' O lam exempt under Section B&P.0"for this read^
N Date Signature of Owner f
rn
FL Q WORKER'S COMPENSATION DECLARATION
,O Q I hereby affirm., under penalty of perjury one of ;ahe 'following declarations:
r F_ O O I have and`will maintain,a,certificate of consent to self insure for,workers'
XW compensation, as provided for by Section 3700'of the Labor Code, for, the
OQ performance of the work for which this permit is issued.
co Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
to `H. permit is issued. My workers' compensation insurance carrier & policy no. are:
�t Z Carrier Policy No. 1
r O UWARRINSUR.A3dCd
J (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 Lab r
3 Code, I shall forthwith comply with those proftions.•
Date: S•- P I -26-' Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to. criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety.,
for a permit subject to the conditions and, restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La•Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date- of issuance.of. such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction„ and hereby authorize representatives of this City to enter upon
the above-mentioned property for Inspection purposes.
Signature (Owrier/Agent) '' -"�"'� / Dated
BUILDING PERMIT ..
:•PERMIT#
CONTROL#
2923,
DATE . VALUATION LOT .,.)��i�1.`$,.
TRACT '
1-3106, S1 1.73,64.60
JOB SITE ..y
ADDRESS
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OWNER
CONTRACTOR/DESIGNER/ENGINEER
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USE OF PERMIT
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1,011"A -L 1'Llt10fi1 ' f FMS 1)ULe NOW
RECEIPTBATE
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 30
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L. f VGrills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
oe
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL. PP OVALS
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 APP VALE
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping I r
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 A P OVALS
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 4141
Utility Notice (Perin)
COMMENTS:
4
•.1
Notice:
Document Cannot Be Duplicated
Date 3/12/96
No. 14.224
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Century Homes Communities
No. 45365
City La Quinta
Street Desert Air Dr.
Tract # 23935-6 Lot # 5
Type of Development Single Family Residence
Comments
APN # 604-331-001
Jurisdiction La Quinta
Permit #
zip 92253
Square Footage
Log #
Study Area 228
1918
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports.-
covered
arages/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 1,918 or $3,298.96
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 TelephoiiE`
Name on the check
By Dolores A. Ballesteros
Superintendent's ' -
Fee collected /exempted by Pauline Pearson Payment Received $3,298.96
Check No. 102154
Signature `` �` �j� t J Q,t'nlk U "'1'- At .1,(�L O/V�
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