9605-152 (SFD)U)
H
N U)
r W
O C")
d Lo
W �
6 Z
r
(o
W W O
� 11,
Z
C)
N
ON
20)
CL
Q
Cr
T Q O
X W
mQU
a: L0
Z_
oo Z)
� d
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
Date fr'' Signature of Contractor"-''�
OWNER -BUILDER DECLARATION f
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 exclusives 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
4.. �� .:/ •:�tw^v:++*"'s/^"".., may... �'M .
WORKER'S COMPENSATION DECLARATION
I hereby affirm unde penalty of perjury one of1the 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
( ) 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 7EN i11IN3. VO, Policy No. ', 21.I,4466(v!
(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 oft "e Labor
Code, I shall�forthwith com I with those revisioons .
Date:'": �r# ;.Applicant.,• r .r.^'"
Warning: Failure to secure Workers' Compensatioi?,co erage 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 andis ate 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 purpo
Signature (Owner/Agent) '✓ Date
BUILDING PERMIT'
PERMIT# CONTROL# .
yi�-� 3385
DATE VALUATION 51A1.ti6 t{t LOT`
T�w:1't1.11i
L
JOB SITE
ADDRESS 79-295 �f1�..r►TLR f.H1:N �1R1VY,
APN 6"432-017
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Crr1': r'.�1' 4'' vir-,itirrtt i r,� )a in it N111!.
1, f \ ori♦..r 1b t.1.1, - 1*41VI I ! 1)'..
f t�.rrv)�' �'r�), ,1Fr�:i r i;`�'ti�.Iutir S�1 r
.0.1. 1 l- Cl S ✓ 1IM .LL \ 1 111 NI 1 S
i335 S -.+. ''1a" SI'K1:ur..4ziv. kw
1 5.35 -,50. "D" MEET, Sidi. #200
SAN hi-X\tAR))IN- f,'A '12.11nx
SAN it kiMRDINO CA 9240R
f1i4)`if'if;I-(V)07
CB1.9 2120
M NJANUN AGUILA R ASS(),?. 1140.
USE OF PERMIT
1iNc.il,t: f AAt11.1' I)W1;1...1,tN4Y
NIS9 PASSFY.0 AAVIi,
ry
KI[ Vl:1tS11.1ki, CA 101Ji9P
'Pt; PAZ. AT 1.A Of 11N lI;A Idc:;RTH
€'f.AN =XG
'%'ttrlt,l't;C:1I.t;3'I'ltC.k:t'tS:11V (,t,ltlJ.t4i 41�
tFyC)Rt:€1l£'A'[')i1 tf>5 FN) 8F
OARA(MCARPOR•T 416.(Ki
Str
Fx'CTIMA i ED COST OF ('ONSTR1!)(.' JON
�fl1<..276.lfi
PERMIT tii'i+'F SUIN4MARV
iM,nN t init::t; E tJ3 If,)1 (i(}0•Az!►-3f$
� if,r,t
CW141%Tr1 lt;TY)N I'.iX 10.1'-000-118-000
$(A6.50
1ti91"fANICAL Viii t 1-t�itt�-X121-0U0
353.iti
ELL I'RICAL Ff Es
St15.vA
p'i.€.INIRINQ P0,1 !Q1A00419-W,
$148 lift
ST01'4C NIX -MON :FEE - RESf13 1 U 1-000-241-000
S10 {3
c t2Ai?tt t F"'',.
S4�i.tii►
1N1z iASt'Rth_ t't1tLr KEE `2K-000-413 :42
ART YN W(W.W,, €`(.ACF:; ft t:,if; 701-OC)()-2$?1•itfi0
i:0_ix7
")lJLi^ (✓ (I 111 iy'Li1,4 JL i�1.N+%j�® i°5r !SAVE PLAN 1_414ic Si.
LESS PRE-cl.riID ETS
-
V1.Gf,.
—�....,
Q 1 VI'Al, !'fl:itl�9 )" FIII1 s DUE NOW
D
5:3,8t)2•fi7
.JUN 0-3
RECEIPT[ tjy
- ..uw�rr
DATE
DA E
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
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
POOLS - SPAS
BLOCKWALL PA OVALS
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 VEquipment
Enclosure
Shower Pans
0. K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas'Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL A PROVALS
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
No. 14535 Jurisdiction
Owner Name Century Crowell Communities
No. 79295 Street Desert Crest Dr.
City La Quinta zip 92253
Tract # 23935-6
Type of Development
Comments
Lot # 22
Single Family Residence
APN # 604-332-017
La Quinta
Permit #
Log #
Study Area 232
Square Footage 1689
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 1,689 or $3,107.76
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 Centrye Crowell Communities
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature
Payment Received
Check No.
Telebhone 909-381-6007
$3,107.76
103483/103523
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