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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_#t t'ItSa Lia Class Exp.
D1tel
r3:Uex 7
A « ��
Dated 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).
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 wor,cers' compensation insurance carrier & oI- no. are:
Carrier �'rvtt,reti"i77.W� tCrlt�tsv; Policy No.H`"'�`� a�
(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 4o the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those prg- vissio�� .
Date: ✓ ",� �t -. r��f App icant'V --''4 5 K
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 UT- oses.
BUILDING PERMIT PERMIT 71 CONTROL#
9603"" 2931
DATE 3/1-31" VALUATION A 11011-76«10 LOT to TRACTD5,(
JOB SITE 79-335 IMSERT vi IND (,',0 lli U APN -604-JJZ-005
ADDRESS
OWNER CONTRACTOR / DESIGNER / ENGINEER
3",t,.,;., :01' CdN"i'URY CROW i 1,L C'4' ;9htl.;'NI. NES
1331 SO. ib" s `M:'t', t535 SO. "u" S t'ItEF T, S E -0200
SAN OC NA,ItI, W6 CA 92408 SAN i3lslcNAR.DINCA. 9240.4
f�?tOM I -t3M7 63(1'91 1.60017 (�'(.# Z 12 t1
USE OF PERMIT r.1 r+Il
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RVRI18 I7t::. C.A.9d50K
TOPAZ @) f.,tl QUM A,`N ORTJ,
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WNRCH/f?f:`.ffo 10 .0(► S
GAE?iiGWCAKPOIR ' 41010 .1;X,
USTIMN- 0,.9 (A)ST OF f`Oiitro'MUC TION
401.276.10
PfMtl7l I' i1+ EIR, SUMMARY
PL AN t:!• RCi t; f� w
l 031-000 43�-3 } 8 .
$541.61,
CL?N S'€'l&K7,,110N 111
101'.000.418-000
�646,50
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101-000-423-000
$20.00
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2.25.000-443,342
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$2fl.Off
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$3,302,67
LESS
PRE-PAWtES.
$0.00
��•� �'} ��� (/ •� f �!� RECEIPT
Signature (Owner/Agent) 1 f " Date—
(This
��
DATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
1
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
l
F.A.U.
Framing
Compressor
Insulation
24z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lathez
Drywall - Int. Lath
O>
Final
Final
BLOCKWALL XPOROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING Aff R VALS
Gas Test
Electric Final
Waste Lines
Heater Final _
Water Piping
Plumbing Final .
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
C'L
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
Final 01
Utility Notice (Perm)
COMMENTS:
-
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. 14229
Owner Name Century Homes Communities
. No. 79335 Street Desert Wind Ct.
City La Quinta
Tract # 23935-6
Lot # 10
Type of Development Single Family Residence
Comments
APN # .
Jurisdiction La Quinta
604-332-005
Permit #
Log #
Zip 92253 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 NOTAPPLICABLE
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.
ac,l I a;
Fees Paid By Century Homes -Topaz Associates LP A Telephone
Name on the check
,y.
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2,905.08
(� Check No. 102154
Signature � \ ��u'�
Collector: Attach a copy of county or city plan check application Corm to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting