9510-092 (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.
9;
iUaGfs, /31i9v
License # , i Uc ass Exp. Date
Date SignatureofContractor/
OWNER-BUILDf 'DECLARVION
I hereby affirm that I am exempt from theZntractor'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 theJfollovring 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 workers' compensation insurance carrier & policy no. are:
Carrier IN Policy No.
(This section nee -not 66.completed if the permit valuation is, for $100.00 or less).
P&Mp- erformance of the work for whiAl this'- kNit 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 shall forthwith comply with those provisions.
Date:. Applicant .
,iWarning: 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.
.f
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 (Jjj� f Ipd(gry.W IIAts officers, agents and"employees?J
2. Any permit issued as a result of this application becomes null and void ifi
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 cancellat'i01�j�
I certify that I have read this application and state that the above informatiodn is
correct. I agree to comply with all City, and StatVaws relating.to the building
construction, and hereby authorize repro entatived of this City to:enter upon the,.
/above-mentioned property for inspec4orv�rpnses-.
Signature (Owner/Age�l) Data
ALC "
BUILDING PERMIT,
PERMI1.sl,0-4097
DATE oiJ�9�
VALUATION $1,1.5 fi .20
LOT 1$
TRACT
.26 152
JOB SITE ADDRESS
APN ,. o
t7- ;9
- �sv�� e:
OWNER _
CONTRACTOR
CENTURY,HOMES COMM UN:1TIE6
Cis1%rFJRY HOMES COUMUNtTIES
1.335 SOUCti D STREET 11200
1535 SOUIN D S'I'it.EET f#200
SAN BERNARDINO CA 92408
SAN DERNAR.QW, Cts 9:2408
(909)lkI-&W ('!R1* ?. 170
DESIGNERIENGINEER
r
(y09i I�6007
USE OF PERMI INGLE .FAN LY D%ME rLNG
r
SYMNAKIM, CQVE A:P LA gAN71A
PLAN 1GA.
FEE DESCRIPTION
FEES
T%kC'P CONST:rW010N .1.942.00 W
GARAGE/CARPORT 521.00 SF
ESTENATED COST OF CONSTRUCTION
11516012-0
PE RJY. ff FEE, S`iTWARY
PT, AIrrC,RECKF E 101-000-439.318 gg79,�3
CONS".l RUC'1 ION FEF 101-000418-000 $695.50
MEOWNWAL, FEE 101 -400 -421 -OAU 3_54.00
ELECTRICAL FEH 101-000-420-000 5141,89
1:1192I3ING rm. 10.1-000-419-(100 1+3.59
STUNG W10CION'M� - RSID 200-000-,2414000 $11.57
O AVING ISE 10.1-000-423-000, $20.00
)-Nk RA +TRUCa "l'U1tE kL-F 225000443-34.2 52,602:40
PREC SE f?LAN 101.-000-441.-345 $25.00
ART MPUBLIC PLACES - RESIC 701-000-255-000 $39.16
1C1T AL CON"STR:UC-" 10N AND PLAN CHECK
• ;LESS P:RE-YAJ13 .FEES •
Q .
�,-02.65
$4;3(32.65
$0.00
'•�� 18
79 T AL . EOU � FEES DUE l�OW '
9 S n
S4y30z.05
'-
RECEIPT
DATE
BY
DATE FINALED
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 DeckExhaust
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
BLOCKWALL APPROV LS
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 / a
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral 2
Pool Cover
Sewer Connection
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 J
Utility Notice (Perm)
COMMENTS: .
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot .Be Duplicated 619-775-3500
Date 111/15/951 Type of Permit La Quinta
No. 1 13900 1 Permit #
Log
Owner Name Century Homes Communities
No. %7815' 15teet Via Nice '
c i ty La AQuinta Zip 92253 Study Area 123
APN # 617*790-018 Tract # 126152 Lot # 18 Square Footage 11942
Type of Development Single Family Residence No. of units 0
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 1942 or $ 3,340.24-
have been paid to D.S.U.S.D. for
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 Spinnaker Cove,-L.P.
Telephone 9,09!-!'-381-6007
Name on the check
`
By Dolores A. Ballesteros
"
Superintendent
Fee collected /exempted by. Pauline Pearson
"4
A
Payment Received
Signature
$3,340.24 Check No. 100754
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
Y