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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
7 411. �
Date-' Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that lam 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.
UNIC.ARE El+its"t,fitANC 5p�25.ft<19 -41ti
(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 Secti n 3700 of the bor
Code,•I. shall forthwith comply with, those proyPsions. .
Date: = "l`/°'Ott ADolicantF� ' ”
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
,,shall
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 Safetyc
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.pDr oses.
Signature (Or /Agent), Date
BUILDINGPERMIT
PERMIT# .CONTROL#
2 9 25
DATE VALUATION LOT
,� 11}4,i TRACT
:311.3/9€; $924,691.40
.?
JOB SITE
ADDRESS
JAPN
70-305 i,HUSERTWIND CO3J.i r
;604..332-002
OWNER
CONTRACTOR/DESIGNER/ENGINEER
p R, F.1Vl'� jr CP,aV E1,[; C0XV1.0"I' I.14ri.E.
•1.:A
CEP111;1-1:' C1:,ICA1EC3i!AM
13. CUN1'11E�S
ig�S- "aCt: r,grf t11GU
ia35 SC. n a 7;', ;. {2003
SAAA1y>iR I�S+.I�N�A..RI NN, CA. 97408
SAA' N 1�1?ti/:l'/��iA)RDiNO cJ A. 02408
(909i��I.600
j�
1 X119 i_60(.�/ �,TL0 X.I.ry.0
USE OF PERMIT
E33:PJJ'rS1Vl�'.Td i1GiJ].il,R tri ��`isttie:"iA'1
LA:
l4t1-.: 0.' :..rlw R-ellV
..WJ' I�YSJkI.,.k4.\"i1V •:
RiVO.-4,517)K CA,9d50 ,
T0PA7-60,iA, QU.1714TA NO, W111
PLAN SXCR
C: iARAt"tIiluAR'{ 011 f.' S'l$.004 I
>N.A'i'.zAWV0 C.C�.K7f OF CO N STRUC'DON
U4,491.40
9'l'UNIff FEE 8111Y1Rr'iA9aY
??id CHECK FEE
V)1431
CONS. rR(ICT!Hl"E 101"000-4118-000
�foi,00
MEC.iltY (CAL F..E 10x:-�it1%-421-OOt7
;a79.00
of C'!'I IC AL F'ER ' I iJ 1 4 J0=421 000
S132.58
co
PLl fl -16ING FW, .1.000-4I MW
$167.n-
C rn
c;`!`ONo NIOTIO14 FAsM '- RE15I:11). 101-{k`1L1-241-000
$12.47
(AAlJil' G FEE
520.00
IFlFRA.3TR1JC't3JCtEflRi: 225-0()0:143-312
SZ ;3630
�
(<(, Iz
ART IN PUB C,\ P11ACF',S - f 131131 ? 701-000-255-000
SUB-'[WAL 1_`01N 111RUCTION.:' AID PLAIN CHECK
$4,601.24
LES I'RL-'-PikID t'EBS
' iffrA.L .efIRNUT FEES Dt7E NOW
S4,64014
RECEIPT
DATE ,
BY
DATE FINALE
INSPECTOR
—_.gV
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 jf
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
'
i,
Final
l'
Final
POOLS - SPAS
�e
BLOCKWAL 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 APPR VALS
Gas Test
I .
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 j
Gas Test
Appliances
Final
!
COMMENTS:
A
,
Final
Utility Notice (Gas)
ELECTRICAL A ROVALS
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
A
A09
FinalI Vv
. Utility Notice (Perm)
Notice:
Document Cannot Be Duplicated
Date 3/12/96
No. 14226
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name Century Homes Communities
No. 79305
City La Quinta
Tract # 23935-6
Street Desert Wind Ct.
Lot # 7
Type of Development Single Family Residence
Comments
By
Jurisdiction
zip 92253
APN # 604-332-002
La Quints
Permit #
Log #
Study Area 228
Square Footage 2073
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 2,073 or $3,565.56
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 AssociatesLP Telephone: _
Name on the check
Dolores A. Ballesteros
Superintendent "
Fee collected /exempted by Pauline Pearson Payment Received $3,565.56
Signature � � Q Q pyl' Az" t
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