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9803-107 (SFD)t— y 04 W .O O W� Z o r` <.�0o f— cD Wa Z 1.Ff. co LO N ON U a) d Q O 0 J LL J C0 < DL LO Z_ ob ::) r` C3 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 714 � 1.031/99 ,Date? a [ / 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 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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code shall f rth 'th comply with tho . siorLs. Dat / Applicant �C Warning: Failure to secure Workers' Compensatio 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 onthis 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 forlpspecti - n purposes. y^ yAignature (Owner/Agent l r Dat ' PERMIT# CONTROL'# µ BUILDING PERMIT.. ' 9803-14117 DATE VALUATION Tp y LOT TRACT 8 7 12 r �ii0.�34.3ii JOB SITE ' ADDRESS 7.� q-4 'Dkr FRT,*tk(%AM DME -1 APN 04-374-002 OWNER CONTRACTOR/DESIGNER/ENGINEER CEN�'RY CRt7WELL COirl�f4liTl rfIES CE.Nr JRY CRIDIVELL CCiNI:'.1UI:Lr11TIES 1535 SO. "U" S'1'uu, ST.E. #200 1535 SO. "D'' Sii EEE',a Ci. #200 SAN BERN.ARDINO CA 92408 SAN BERNr1,RDINO CA 92408 (909)381-6007 (~1.11,# 2120 USE OF PERMIT �I4) PLAN 213 - SF13 -DEL R.EY kT i.A QUiNTA NORTE - %75 FLAB C -CF RFDUCT10N APPLIED TRACT CONSR1UCTIt7N 1.,24540 SF POiY.C:WAT1O7 :15.00 SE 4ARAC'MYCA PORT 630.00 `1F ESTIMATE COST Or, CONS"i RUC"f10,N 13f:1,3311.�1s11 1pOMIT FEE SDJ111'MARY FLAN CHECK FEE 101-000-139.318 $403.53 CONSTRUCTION FEE 101-000-4113,.000 $534.00 MWiANICA:L M 101-W0-421-000 S47.00 SLEMICAL M 101-1000-420-000 $104.68 R1,I3AdF11 fC . 101-000-419-000 $118.00 STRONG MOTION .FEE -RESD 101-000-241-000 $8.04 GRADIN0ITM6 10.1-000.4213-000 520.00 WRAS`1'R C 11'"O..tE E -TIi 22--X0-443-3= 7, $1.798.91 PLAN CtWiCK EEE 4-101-000-439-318 •.5333 7.64 SUB -TOTAL CONS'1'RCOtMON.E1.ND PLAN CK- CK $3,! 14.16 r IX -SS PR&RAI©FS:Ek 4341-1.64 'TOTAL PERMIT FEF_'S DUE NOW JUL $2,766.52 . , RECEIPT. - ' DATE BY / DATE FINALED INSPECTOR Ar INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs foe:Ducts Underground Ducts Forms & Footings Slab Grade Return Air, Steel _ Combustion Air Roof Deck o - 7- z _ Exhaust Fans O.K. to Wrap F.A.U. Framing .( - Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath --17 Drywall - Int. Lath - —Q Final Final BLOCKWALL APPROV LS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover. Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines - ($- 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 4 final _ Wtility Notice (Perm) COMMENTS: 1! r. Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 7/22/98 No. 17363 Jurisdiction Owner NameCentury Crowell Communities No, 79-065 Street Desert Stream Drive City La Quinta Zip 92253 Tract # Lot # Type of Development Single Family Residence Comments APN # 604-374-002 La Quinta Permit # Log # Study Area Square Footage 1,245 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 1.93 X 1,245 or $ 2,402.85 the property listed above and tjiat building permits and/or Certificates of Occupancy for this square footage in this proposed project riidy now^be issued Fees Paid By CC/Foothill Independent Bank/Ed Knight iaP hone 2' Name on the check N. By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment Received $2,402.85 Check No. 604539 Signature NOTICE: Pursuant of Asilmbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run frd/n the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. 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