9604-098 (RPL)U)
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjuryy'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 # f Lic. Class Exp. Date
"747 A� � l�l3'i
llf�
Date Signature of Contra ctorf
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�Ssa to d:EMy�w 9rkers' compensation insurance' c arrq•'e�r2&,p 1,ig no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I,s�all fort with comply with t sem• rovisp ns.
Date: d1fy -$t�J , . Applicant�� �'_,_:,:'.,
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 pursuantI6o
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
`th^e above-mentioned propertyfoforinspection purposes. /c/6 Signature (Owner/Agent) �^" Date" A!t
BPERMITq CONTROLp
,BUILDING PERMIT
►�-;�� 3159
DATE VALUATION LOT TRACT
41616
JOB SITE .f •�t, APN
ADDRESS 79-345 DIMRT WIND Cr
I OWNER
79 -US DESIERT WIN.0 (-,f
LA,. QUItNTA Qk 92253
(909) 3WI 6o
USE OF PERMIT
ANi) OR "S411%
K-K)II/.,& 7PAO SIJ i.
CONTRACTOR/DESIGNER/ENGINEER
S" IEV:E' .DODSON CIONS�� lifJCi ON,
Cil. KEi?ILAL, OI."I`Y OA. 92234
CUT,## 1(44
FiK))`L Eli'dINOR.SPA 15,000.00 LS
ES 1'.1M,AT1,`. T COST OF CONSTRUCT ION
I'h;H41,11' 3+'.i±E SiJiIMM—A3iy "
PLANT CHECK FEE 101-000-439-3133. S105.30
CONSTRUCTION FEE 10.1 •-000- 418 000 $16 2.00
MECHANICAL FEE -- 10.1,-000'421-000 $24.00
ELECTRICAL FEE 101-000-420- 000. S45,;00
PLUMPING �'���':.. PO .101-060-419-000 $27.00
SUB -TOTAL C.ONSTRUC TTON .AND PLAN C Hf
LESS PRE -PAID
1510 0.60
$363.30
$0.00
TOTAL PERMIT FEES DUE N '$363.30e'
RECEIPT DATE BYDATE FIN ALED '. INSPECTOR
/•�' r
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
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS.
steel
Set Backs
. Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test tip
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 ConnectionEncapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final ...
Utility Notice (Gas)
- ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough.Wiring
Low Voltage Wiring
Fbitures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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. 14230
Owner Name Century Homes Communities
No. 79345
City La Quinta
Tract # 23935-6
Type of Development
Comments
Street Desert Wind Ct.
Lot # 11
Single Family Residence
APN # 604-332-006
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 228
Square Footage 1433
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 1,433 or $ 2,464.76
the property listed above and that building permits and/or Certificates o_f,Occupancy for
this square footage in this proposed project may now be issued. ;.
Fees Paid By Century Homes-Topas Associates LP Telephone
Name on the check
• i Jam• � By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2,464.76
Check No. 102154
SignaturePn,A,K.Q0'AAbP � �t n Ac��v�
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