9510-101 (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.--, ,
� 4"3 B �` ly3i; )ti
License #- Lic. asks tFxp. Data,-,
"'
Date f Signatureof Contractor F
r /.
/ OWNER -BUILDER 'DE LAR_TION +sem
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).
( ) 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 issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section .need not becompleted if the permit valuations for $100.00 or less).
() I certify iga'tNn �lNperformance of the work for which Asperr%it 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
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 pursuant to '
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City ofIdbiakWell"s;'141officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void'if r.I
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 the
above-mentioned property for inspection" urpooses.
Signature (OJmeryAgWb ,- Date
ALC '
BUILDING PERMIT,s
PERMIT,
DATE womsVALUATION
41tU,12;.
LOT 1TRACT 2614-2
JOB SITE ADDRESS„
4 A :_ _ <.
b1�-79{i Yom'
OWNER - - = - __-
CONTRACTOR
CFNI1 JRX 1(()MIFS C'0I41tW NnIFS
IrUNIf It) IffI10N1E:St'°tAiAti'NIllRN
15:1! 1,0!Ai(6s u,L.-'T2oo
1535 SOUM D .STP *Fr #200
SAN 13 RNe11Li3INO CA 92400
SAN BERNARI IN, C'A 92409
th IA91-44llt'7
DESIGNER/ENGINEER
(009)381-6,007
USE OF PERMI ING11" FAIMIL`i L)•SA+ ELLING
SPIN` AKFRt'r9Vf A'I'L"E LA t, UIN'1'A
PLAN IVR
FEE DESCRIPTION
FEES
2'RA('.'C C N«iTRUC"1'10N 1,81100t Sr
0ARA(MCARPOW17 S`"IA) 8R
RIR ALATED COST OF CbMS T RUC TION
110,123.6i,
PERMIT FRE SUMMARY
CONS'.TR,lW71'ION I P1i I01-ODO.4113-000 S678 N)
Mt 3iANICALfP,C 101 -OO() -421-000 ts«.60
ELl C'!`MCAL F.EL 101-"-4 0-000 S11832
PI.1AMINO "-'F, 101-QC>41 1 dad?()()
510Nfs'NIOTION FVE - RESII) 10040-241.000
GRADINQ k'f li ,01-014-4134M Lt).tlf1
1WRAk;_I`R0C*Ff1XI; FE 225-t}Ot)443 342 SS:; 77 78
ART 1N PLaBLICPLA(,' S - 701-000,25,54M SZ5 1
SUB-IT)TAL tb'C)N91R(�f`TIONT AND MAN (�10"C K
$4,t3ts,o
U 16 1995 LESS PUPAJD FEES
= SOW
TOTAL PFRNII ' FEES DUENOW
$4,136.65
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 Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation G
+
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
is
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
A
O.K for Finish Plaster
Sewer Lateral
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 All
Utility Notice (Perm)
COMMENTS-. /, V���f�
�OT//1�(/S /l67
a
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111'
NOTICE: Indio, CA 92201
Document Cannot . Be' Duplicated 619-775-3500
Date 11/15/95 Type of Permit La Quinta
No. 113891 Permit7F
Log
Owner Name Century Homes Comunities
No 047.820 � 8tr-ee# Via .Nice_
City La Quinta . Zip 92253 Study Area 123
APN # 617-790-030 , Tract # 126152 Lot # 30 Square Footage 11840
Type of Development , Single Family Residence No. of units
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 1840 or $ 3,164.80
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.
TeWQ hone 909-381-6007
_ Name. on the check
By Dolores A. Ballesteros
? 'n{
•:
Superintendent'
Fee collected /exempted by Pauline Pearson'.
Payment Received
Signature L� , , Q,=� 4 AAA JQ
$3,164.80 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
o i",