9511-135 (SFD)LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
o=)Section 7000) of Division 3 of the Business and Professionals Code, and my
r� Q License is in full force and effect. 314473 8 1131196
r- W ^ License # J af_ Lic. Class ��Date`-
Date /1/Y.�( "I SignatureofContractor `,.f^ ::-.w "^"'�
O %.,
cp H rn OWNER -BUILDER DECLARATION
J W I, hereby affirm that I am exempt from the Contractor's License Law for the
0_ following reason:
(n ( ) I, as owner of the properly, or my employees with wages as their sole
z 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
N
rn WORKER'S COMPENSATION DECLARATION
vd Q I hereby affirm under penalty of perjury one of the following declarations:
g Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
L Cc 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.
p J J ( ) I have'and will maintain workers' compensation insurance, as required by
C0 Q j Section 3706 of the Labor Code, for the performance of the work for which this
p U permit is, issued. My workers' compensation insurance carrier & policy no. are:
d rn H. Carrier Policy No.
�
z (This. section 6—i6d id1Wel'completed if the permit valuatid0Vis f6d$1.00.00 or less).
00 Z) ()� 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
g workers' compensation laws of California, and agree thatA61 should become
subject to the workers' compensation provisions of-Siction of-Section3700.of the Labor
Code,%sh ,I fo with comply with those prov�ohs.
Date: �f f3'' Applicant
Warning: Failure to secure Workers"' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, intarest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as re ult of this application agrees to, & shall, indemnify
& hold harmless the tyybf(`4iiAlWii'[s-,Nts officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellationl,
I certify that I have read this application and state that the above information Is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City`to enter upon the
• above-mentioned property for-inspectionf,pupur {poses. �.
-.._ �By-
Signature (Owner/Agent),,, Datr3%(
ALC9
..BUILDING PERMIT
PERM IT$!511-135
_
DATE" x�rry`i`
VALUATION LOT ` TRACT
JOB SITE ADDRESS 79-2115 DIANI C DRIVE
APN 604-312-1005
OWNER
CONTRACTOR
CENTURYap'(�'��HOMES] C'(`(,�Jy�i(iv(��VNI`rIES
/f' �/ ^/� ((!+ /' dj� 1 ry��'�rjj�[
F..L'i1v111wl AI<J*'IFIS 1- 01111 \'64.N i.i 3.s
1.53 SOMA T) STREET 7'Y200
153a SOUTii .i3 SlREEr #200
SEAN a3OUgARDINO CA .92409
SANBERNARI DNI , CA 92408
(909)381-6007 CBLH 2120
1-W7
DESIGNERIENGINEE R
/
USE OF PERMITs.:fiQ . ; HuVill. ' 1JWWA,1044,i
I)EL ..RE Y V 'LA QUINTA.'NORTF,
I'L AN 4"XB
FEE DESCRIPTION
FEES
TRAM.' 1' t .)NS`.I',XUC t`1(3:JN 1,754.00 SE
f_ APA<<.PjcARPUP'i' 42.5.00 S! '.
11,5 TIji AT'ED Calf OF CC NSTRUC.` li0N
103,572.20
PE.dtM.Yr TWEE Vit[ MNIARY
PLAN C1:fECK KPA-7, _101-000-439�31.8 $553.45
CONSTRUCTION FM 101-00041.8-000
L ECHANICAL FFL 101-000-421-000 $55.50
E, LP:C`Yf UCAL FEE 101-000-420-000 41312"
L?t ti fitl?\i'C� FY?B 1 0 1-00041.9-000 _ $156.00
V ONG Mi rcn.N FEE - REsm 100-000-241-000 $10.36
CO2 AD1Nt3 FHE i 0 i -000-423-000 $2+1,00
INF RASIWLICTURE F13—t, 225-000-443>342 r4330.37
,,VIT .1N PUBLIC PLACTS - QST, 701-000-25 g 000 $2tt.00
SUB-TOT'AV C;'ION AND PILAN C.lUrXIC
$3,032..60
_ .....` LESS PRE -PAID FEES
$0.00
_
^•_
:TOfAl, PERMIT FEES DUE NOW
S3,932A9
+0V 3 0 1995 T07fAc, P ROHif- • iw.camrr rEE.i
3,93160
r
RECEIPT
DATE
BY
DATE FiNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Bond Beam
Forms & Footings
J
Slab Grade
?j
Steel
Roof Deck
Final
0.K to Wrap
PLUMBING APPROVALS
Framing
Waste Lines
Insulation
Water Piping
Fireplace P.L.
Plumbing Top Out
Fireplace T.O.
Shower Pans
Party Wail Insulation
_
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
eel
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground' Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines .
ritual
BLOCKWAL(gPOk6VALS
POOLS - SPAS
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
COMMENTS:
I ELECTRICAL (APPROVALS I
Temp. Power Pole
Low Voltage Wini
Fixtures
Main Service
Sub Panels
Exterior Receptac
G.F.I.
Smoke Detectors
Temp. Use of Pa
Final
Utility Notice (Per
Notice:
Document Cannot Be Duplicated
Date 11/28/95
No. 13910
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Jurisdiction
Owner Name Century Homes Communities
79205
No. Street
Diane Dr.
City La Quinta zip 92253
Tract # 26188
Type of Development
Comments
Lot # 13
Single Family Residence
APN # 604-3.12-005
La Quinta `
Permit #
Log #
Study Area 232
Square Footage 1754
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 1,754 or $3,016.88
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. ' ~ Teleplione
Na►:ie on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,016.88
Check No. 22479
Signature �A,���.
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