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9603-044 (SFD)U) N W �O ::) ch 1�0�+ W T _rn .0 (001 wWT (0 I— CL Z ce) u) N 0� U Q Z LO QIM 0 LL 0 J J mUU O a 0) `t Z r-0 J LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjurythat 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 !I�lE£ss L4 1QGi1 7 Date Signature of Contractor 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 (Seo. 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 U.NICARE,, INSURAINQ Policy No. SA:I.S`W 95.0 (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 �yCode, II shall forthwith comply with those provisions. r- i ,Date: /`!' eMP Applicant— Warning: pplicant 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 poses. !' i / .a 7QSignature (Owner/Agent)�f'�'^�"rate"7��%�� BUILDING PERMIT PERMIT# CONTROL# "� DATE AMP% VALUATION S-101,276.10 LOT TRAC .935-1 JOB SITE 5 V'r- Wt W`r" COU UT APIN 604_332_003 ADDRESS 'OWNER CONTRACTOR / DESIGNER / ENGINEER Ci,I N 1:411 it c»`ID`i ILl!..,i! f.OMINWIN VI INI - L.,i:MIU. ZY CF.OWEL1, CtJl4 NIUI+)ITEF'S 13.15 :,No. fto" \ rju".L•'`'1 ' SOL Q00 195 i0, 'ItY, is VitEl:t ST42 SAKI $I,RNAR;DIN, CA 924109 .8. SAN BERNAW)i Its t Y40R f5►O j R I.-�01U 7 (900)M 1-6007 C' .x,fJ 2;2() I:1YAiU�IAIV 1�' «Jll..ii �}: titi`i+l'1t� A USE OF PERMIT :ei.(Vt:}S..1s l�Alt'I.tl.,�' ll'�Vtsi,.Ll�j%s �•?&9.1>A:�tif�Rr�+ A'�r1� ' . s2T'V1?EM41I. C° 91SAk PI_,A'N ..4K_R 'f't(F1M C()N:f VRUC I'10N I,,6VJ.00 SF PGrR<w'H/PATTO 106,00 SF 0AHt10FA_-AP,P0 °r 416.00 8F CUST OF C,00�ts�,�RVC7J0N 101,276.10 (y A;g7�'y /�3 (� �] �/j�y (Iia�'CMATP�) . .E .F1RMQ i. N� CJ.0 ♦inJ.MMAR Y PI.Awr.1�:q,'+'.f! i(?i tlfMl-49-it.$ �44t•.ti! CO IN`S'I'1tUC'i tON FEE, 101-000-41 U00 i'f3CfIf1N[Ci�i.1r1:3_T 10:1-000-42..ow FEL FJ T)I FE -Lr 101-000-420-100 $11564 �. 1,000 -419-000 3148-00 101-000-241-000 1NFRAS11W(;1r1JR 7Kh' 22Q•100-4 3- 2 AI!ZT IN PT,Jl3Li.'c,,*!°LAr—� - xtr,�ITa 703 -0(VQ-: 5�4100 LESS t'rP.AI1X3T FS . w6o 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 L Return Air Steel Combustion Air Roof Deck Ole Exhaust Fans O.K to Wrap 140 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 JW Zp Drywall - Int. Lath Final Final BLOCKWALI A PROVALS 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 APPR VALS 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 7V Encapsulation ,Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas)I :4t OKI 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) Notice: Document Cannot Be Duplicated Date 3/12/96 No. 14227 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Owner Name Century Homes Communities No. 79315 street Desert Wind Ct/ city La Quinta Tract # 23935-6 Lot # 8 Type of Development Single Family Residence . Comments By Jurisdiction zip 92253 APN # 604-332-003 La Quinta Permit # Log # Study Area 228 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 1.72 X 1,689 or $ 2,905.08 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 Telephone ' Name on the check - Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Payment Received $2,905.08 Signature pva u Qjn�ti \l ; o nR CljxV\, 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