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9511-140 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with C', W Section 7000) of Division'3 of the Business and Professionals Code, and my O � License is in full force and effect. 314473 13 11,311% r�. W ^ License #_ Lic. Class Exp. Date ZDate Signature of Contractor c'o 0 a� OWNER -BUILDER DECLARATION LJu' IU — I hereby affirm that I am exempt from the Contractor's License Law for the co following reason: I. -U) ( ) I, as owner of the property, or my, employees with wages as their sole Z compensation, will do the work, and the structure is not intended or offered for s sale (Sec. 7044, Business & Professionals Code). () I, as owner of the property, am exclusively contracting with lice contractors to construct the project (Sec. 7044, Business & Professionals Code). () I am exempt under Section �B&P:C. for this eason Cl) Date ff &i, Signature otCtivner„ N psi rn 1% WORKER'S COMPENSA [fIONON JIDEC RATION CL Q I hereby affirm under penalty of perjury,c6eof the following declarations: C) Z () I have and will maintain a certificate of consent to self -insure for workers' �O compensation,. as ' provided for ' by Section 3700 of the Labor Code, for the X W LL performance of the work for which this permit is issued. O J J ( ) I have and will maintain workers' compensation insurance, as required by DO Q U Section 3700 of the Labor Code, for the performance of the work for which this O U permit is issued. My workers' compensation insurance carrier & policy no. are: d LO Carrier Policy No. 1 Z (This sect on need not be.completed if the permit Valuatio is.for $.100.00 or less). co�� 1�C) A16tN,;t,I`r�dt co Q ()Ice iffy at�in a performance of the work for whic this per it is issued, I shall not employ any person in any manner so as to become su jed to the workers' compensation laws of California, and agree that if.lyshould become, subject to the workers' compensation provision' s..of Section 3700 of the, or 6 Code, I ,shall forthwith comply with those->rovisions. 0 Date: f "? t Applicant Warning: Failure to secure Workers'�� " cation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the' i jN7l$, its officers, agents and employees. t 2. Any permit issued 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. 1 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 relatingto the building construction, and hereby authorize representatives ofthis- ity to enter upon the • above-mentioned property for inspection purpa._ o -s s`� iSignature (Owner/A9errt)-"""'`��� / Dais ALCM BUILDING PERMIT PERMITI.��l-�1 YY DATE 9..31 1`,10 VALUATION tt l�Jf ii. t LOT IN TRACT ZOIW5 JOB SITE ADDRESS 79-180 IXNE DRIVE APN 6iW.31:1 662 OWNER CONTRACTOR CEIN IRY HOMES COb1MUNi'i'lE5 CF:ITfURY 1Lf0A4.V:S C 0J&V1 r33 Nf J1TFS 1535 Sf UTI -111) 9 ;�F<;' A vo 13-33 SOUIR D STREET 4200 &AN BE1tt�IAfctD]NO CA 92408 SAN 13ERRARDW CA 92408 (909)381-6007 CBL,# 2120 DESIGNER/ENG[NEER USE OF PERWT .W41U I•AkUL i� rte, LLING J✓"�}t1MY U,e c@ LA QU[N A NOWM PLAN 2XC FEE DESCRIPTION FEES TlttvC r C:<)N57'Ri7C1`]ON 1,47801 8F GAR 4LV3 /CARP'OR,' 413.00 8F EESTI3WATED COST OF CONSTRUCTION 8813:50.20 1P . 41-C1� EC'SUMMARY PT AN CI IECK FFF 10J4.)00-439-318 $409.47 CONSTRUCTION Fa—' 101-000418-000 $590.00 MECHANICAL FEE 101.000421-000 $49.00 HL.EC' MICAL FEE 101 -000.420 -OW 5123 49 ..I;f1 vItH1NO !ter. 101 -OW -419400 $l, a LO S7'O'kdC3 mOTION P -GE - RE&D 1.00-000.241-000 $8.84 rn Ct1.ADING FRE 101-000-423-000 M.00 o 110WI-RUCCU1ZE FEE 225-"-"3-342 $l.�df17.88 CEJ © SUB -TOTAL, CONSTRUCTION AND PLAN CHECK $3x416.68 IX SS PRE -PAID FEES $0.00 TU M., PERll IT 1+'EFS DUE NOW x3,4161.68 TOTAL PROJECT PERIVIITi FEES 3,416.611 RECEIPT DATE BY DATE RNALED 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 Combustion Air Roof Deck Exhaust Fans O.K. 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 P ROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test 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 Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final to 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 r Utility Notice (Perm) F , Desert Sands Unified School District Notice: 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 11/28/95 No. 13915 Owner Name Century Homes Communities No:_ 79180____ Streei­— Diane Dr. City La Quinta Tract # 26188 Type of Development Comments Lot # 18 Single Family Residence APN # 604-313-002 Jurisdiction La Quinta zip 92253 Permit # Log # Study Area 232 Square Footage 1478 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 1,478 or $ 2,542.16 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 f w Payment Received $2,542.16 Check No. 22479 Signature P u�� a_e/V11_ 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