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Home My WebLink About9606-067 (SFD)U) H N to W OAC'`) L0 �W� Z rn0 GO W W I— CL rn Z L0 N :o N CU CT) C Q T Q O QJ J M Q_ U rn r � Z ccb> Q J LICENSED CONTRACTOR DECLARATION z ._ 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 Ezp Date 7' 1 t#1� Date / Signature of Contraco.�- 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 tf e -project (Sec. 7044, Business & Professionals Code). rte. () 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. l ( ) 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 ' 71,M11i INS. CO, Policy No. 204206 6,401 (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 rprovisions of Section-'3700.ofthe'Labor Code I shI f `rhwith comply wi h•those•proyisl Date: _� a ..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. ,r Signature (Owner/Agent)�� Date / BUILDINGPERMIT PERMIT# i CONTROL# ►6.067 3 513 DATE — VA 11ATION LOTTRACT '587;174.40 24 JOB SITE APN ADDRESS 79-315 DESERT CIMST DK E. 6"332-019 OWNER CONTRACTOR ! DESIGNER ! ENGINEER CENILT1;.Y 0,1101tirFLL COMMUNI[T1E.. CER1'C{. RY CROT4'E'L:L Ct?MMUNIMI'S 1335 SO.O” S1`R•Err"S"rL:. kno 1535 SO. "O" STRU r, SIR #200 SANT 13HRNARC).UNT, C.A. 9,2,408 SAN BERNAktt INO CA 92408 (904)381-6007 (909):381«6007 CML.4 2120 ArNJrMIN AGILM ASSOC. INC. USE OF PERMIT 82 (AA4,FAMILY 1AVs1LNG 5459ASSW> fiAVE IsME25iID , CA 5210. TOPAZ. A7' 1,A QUINT.A N0XfR PLAN 2Mj. A T 2JIVI'1' C(:}'t 111 RUC710N 1,433 00 SE PORCH,lMA.TI.O 85.00 Sr GARAC UCARPORT 420.00 SF F..STiA1ATED C%J,ST OF CONSTRUCTION N 87,174.41) Pi:;A'K CHEC,'1� FOR 104-000-439--31.8 S495.77 - CONdSTWC:'13024 FIX. 10k000-418-000 x()00.4113-000 $5135.50 1M ECIIANICA1..0XI. 101-000-42.J V0 . 1r1.f3=tilt=N..V1:li ' -101.mo,-420-000 $1.0" X t?t 17-1 ` f-'{ttfNffgNtN 1<TF1 01 ! 1 J 9-000 $148.00 SIOi+fr: NIQ'; IONPM-1� SO) 101-000-2c41-400 $18,72 aitAt:fNofFIM 101-000-423-000 1.20.003 Q _I #'N RAS 1'ItUC*11JM FTFR 225.000.443-347 $.1.935.99 � SUB -TOTAL t✓OM.�'I.RLlMION AND PLAN QUECK $3,354-54 LESS PRE -PAA FFES $0,00 . . .L.OTAIJ AIER.M..r t.L'.1N DI A'. N4JW $3,354-54 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 Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath - - Final Final' BLOCKWALL APPkOVALS 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 APPRO ALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out fEquipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral ell Pool Cover Sewer Connection d7l I UEncapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL 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) APPROVALS ! COMMENTS: Notice: Document Cannot Be Duplicated Date No. 6124196 sert Sands Unified School Distri 82-879 Highway 111 Indio, CA 92201 6t9-775-3500 o'"o CERTIFICATE OF COMPLIANCE APN # Jurisdiction La Quinta Pauline Pearson Payment Received Check No. 529895 l0r ,t n rurl\- 604-332-01 9 t4629 owner Name Century Crowell Communities Permit # No.Street Desert Crest Drive Log # City La Quinta zip 92253 Study Area 232 1433Tract #Lot# 24 Square Footage Type of Devetopment Single Family Residence No. of Units 1 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patioVwalkways, 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 in the amount of 1.84 x 1,433 or $2,636.72 Government Code 53080 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 Foothill Independent Bank/Century Crowell Telephone 360-7464 Dolores A. Ballesteros 79-3ts 2393s-6 By Superintendent Fee collected /exempted by $2,636.72 Signature P ., ,,-^ n \- Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - ApplicanUReceipt Copy - Accounting