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9603-051 (SFD)f— N U) r W Q Z) r\ Q U) W Z O 0) W W U) Z co LO N ON U °) aQ Z Lo Q CEO tL O_JQ m U U O d rnH ;I -Z_ ao � �d 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 #i•i1F3b Uic. Class Exp. Dalin, Ii9% 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 (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 s%ecl. My tw�orke s' compensation insurance carrier y&#pollicty�no. are: Cartier 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 L�bor Code, I shall forthwith comply with those provisJJons . Date:,- .. ! a"�T Applicant ;..- Pte.,:.' Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspectionurposes. /] Signature (Owner/Agent)`��°rr�"E t"�DateY'"rev— -� BUILDING PERMIT PERMIT�f CONTROL# MI 3A 6 5593" 69.wr 2936 �' ` DATE VALUATION LOT. TRACT,�i JOB SITE J:H..fftiy4!!ilw4QlYtA, YY1rIMJik;idUiSi APN 3111'1-.tr•3Ir11i6tf `'ADDRESS 'OWNER CONTRACTOR/DEESIGNER/ENGINEER f,ii1UPl :TI( "' 4 1Jirl�3E.' . '. ry*tiyy, ciioYYrY ..tr cJA ,y.,,lrrvus 1S3_5 SG. "W !TFRE ni; STE. -11 00 15-1580. -D' Irl ;11. #200 SAFE 1.3±sRf1i111,DIN, (CA, 92408 SAN f4!"sl:�Ne1.12IMNO CA 07-40,114 1-4007 (000)191-6007 t B11$ 2170 � ... ,,,• rr+.r ro.r. r. n a rye, ... ,y i)1"wI ;;V*VRR14 A OUliAR d6 /1tlaaL Clj i USE OF PERMIT SiNk.4,,14' 14W11A 134YE[.LUNOr 14 +9 f'A3,8liR0 AVK t21M8L fs, CA 92'S05 ;. 'PAZ 4k,LA.Q11jNITANCKI*E PT AN tA�'12 %✓ r ii(rtr "!' �.'tJNS'f'1.tC/(,"1'Ic3y 1,475 (0) yF ,€ f�caldf Fi/f�l� 'T(+ W6.06 ;Sp ✓ OA RA.00CARPOR oujo S.F 1'ERA11 ' i} VE, 8 1MN ARV IN AN-010Vf,� 1f?1-01K1.4i9.ifit �SIf. Sl) IC�2�t!*f_1, 101-00-4.18 wo 61`ri 5t1 _ 1 ��-^—:71-1 ktL,tA1A ,NI Af_ Jsl:li 101-{t{{)(11-421.00 51) tsf,lil'"F'kiJlk r�Z, 14 101.000.420-001 CIO P1 f11t-ifilV;;111117 I(1 .-WO4104MNl S1141A 00 © O7 OR,P ANtf 14-,b 101d)0-12140) "JiLll.is fNF12RVVR01'"1'fIRP* FER 22:5-(0J- ,11-,k42 is �( USS PRE-VAID FEES $0,00 TOTAL PERMIT FE -Els, DUE NOW S 1, 5's 2.", 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 j Combustion Air Roof Deck Exhaust Fans O.K to Wrap Je, F.A.U. Framing 1 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 APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location. Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPRPOVALS 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 COMMENTS: l Final Utility Notice (Gas) ELECTRICAL APP OVALS 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) Iff Desert Sands Unified School District Notice: 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 3/12/96 No. 14234 • Owner Name Century Homes Communities No. 79330 City La Quinta Tract # 23935-6 Type of Development Comments By Street Desert Wind Ct. Lot # 15 Single Family Residence APN # 604-332-010 Jurisdiction La Quints zip 92253 Permit # Log # Study Area 228 Square Footage 1475 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 1,475 or $2,537.00 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 "x:909-381-6007 Name on the check Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Payment Received Check No. Signature PaudgAAQ 1 c 0 A A A n/i^ $2,537.00 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