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9511-138 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm 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. 314473 13 15 11% License # Lic. Class Exp. Date Date Signatureof Contractor OWNER -BUILDER DECLARATION I hereby affirm 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). O I, as owner of the property, am exclusively �contracting„wlicensed contractors to construct the project (Sec. 7044,Business'&,Fr6fessionals Code):' O I am exerripL t under Section .,TB&P.,C.`br4 is i6aason.,--_ (Date �r--Sig`natGTeofOwner ,,-.-Tom___. WORKER'S COMPENSATION .DECLARATION I hereby affirm under penalty of perjury one of the following"*,declarations: i () I have and will maintain a certficate 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. (This sectio need,pQt l*,P ompleted if the permit valuatidn is.f(5r�$1 90.00 or less). () I certify that in the performance of the work for which this permit is issued, 51 I shall not employ any person in any manner so as to becorne,.subject to the workers' compensation laws of California, and agr,th' 64'I hould become subject to the workers' compensation provisi6ns-of Section 3700 -df, the Labor Code, I shall forthwithAcomply with those.provlslons. Date' `/ D%�;1 Applicant Warning: Failure to secure Workers' .Compensation coverage is unlawful and shall subject an employer to criminaldpennalties and civil fines up to $100,000, in addition to the cost of compens b n, damages as provided for in Section 3706 of the Labor Code, intarest 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 application agrees to, & shall, indemnify & hold harmless the Ci4/ofbAhnM-11A 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 t�habove information is correct. I agree to comply with all City, and State -laws relating to the building construction, and hereby authorize, representat'Iies-6f this City„to-erite� upon the above-mentioned property for inspectioonnpurposes. Signature (Owner/Agent),=� 'Af '�' }Date! e � ALO0 BUILDING PERMIT PERMIT451,1438 I DATE VALUATION L't,tY.lt I"11 LOT O TRACT LO t E 1* JOB SITE ADDRESS 79,175" DMNE ,DR. td,4 _ APN 60431UGS OWNER CONTRACTOR CF_NT11R1' EIC?mn COmmuNMES CENT TI vi,R Y HOMES C0MN."I TI MES 1535 SOC UM D S TR EF 1' 9200 1533 SOU t -H D STREU 6200 SART BERME RDIltiO Ccs 92408 SAN'BERNARD1N CA 92408 (909).81-6007 CSLH 1120 (909)3RI-6007 DESIGNER/ENGINEER USE OFPERMITAPOi .'. 't A`d d1.VVL.Ll.AtNt,J DHI.. MY @h1,A C,JWrA.N01 TF, PLAN 3 -KA FEE DESCRIPTION FEES TR&M' C0 NWl.' UCl'10N 1,618.00 SF 0ARAGrYCARf10RT 417.00 8F .lTie ATED COST OF CONSTRUCTION ION 96,030.60 P'ERNIT .FFM SUMMARY IN CHIECK Fr:13 $5228.08 CONST) t7Ct' ON .FIM 10.1-000-418-000 1626.00 r_ ........ ---� EVIS "t" ANtC,A1.1T.F 101-M-421-000 $S5.50 EI EC1RICAL FEE 101-000-420-000 $128.47 PLUMF1[Ni+ FEE 101-(N1[t^4I9-00A $1.33.00 LO © a-)1< STOG 1bLOTION FEE - RESYD 100-000-241-000 19.60 OR AUING FEE 101 -1}00 -423 -WO x2,0.00 0 T11fFRASTi2U'CTURlE FEE 225-000-443-342 $2,160.69 l � �O ' SUB -TOTAL CON19171kUt:'I'ION' AND PLAN CR1?CK $3,666.34 LESS PR&PAID PE1'sS $0.00 TOTAL Plri NIff F EES' UE. NOW S3,"6.34 TOTAL PROJECT PERItiii.i T FRES X666.34 RECEIPT DATE By DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Bond Beam Underground Ducts Forms & Footings Equipment Location Ducts Slab Grade _ Return Air Steel 7 Gas Piping Combustion Air Roof Deck Waste Lines Exhaust Fans O.K. to ,Wrap Plumbing Final F.A.U. Framing Compressor. Insulation _ EyVents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Z Gf Condensate Lines Party Wall Firewall Exterior Lath Drvwall - Int. Lath l i Final Final BLOCKWA.I I'APkOVALS 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 APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbina Toa Out Eauioment Enclosure Final COMMENTS: IFr Final C 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 Z ! Utility Notice (Perm) r` Notice: Document Cannot Be Duplicated Date 11/28/95 No. 13913 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE APN # 604-312-008 Jurisdiction La Quinta Owner Name Century Homes Communities Permit # No. 79175-- Street- Diane -Dr.— v% Log # cit, La Quinta Tract # 26188 Lot # 16 Zip 92253 Study Area 232 Square Footage 1618 Type of Development Single Family Residence No. of Units 1 Comments 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 1,618 or $2,782.96 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 L.P. Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Telephone Payment Received $2,782.96 Check No. 22479 Signature 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