9510-093 (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. �)�A7 k3 �,� ��1l�>6
License #,, i` WPM fEicp. Date. , �-1 -
�Date ntractor 16:
OWNER -131.1111 -DEW ECL�Aft 4 ION
I hereby affirm that I am exempt from the�Ccj actor'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
contractorsAo construct the project (Sec. 7044, Business & Professionals Code).
O I am exempt under Section ; B&P.C. for this reason
Date Signature of Owner
r �
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to, self -insure for workers'
compensatiori , a"s 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 be completed if the permit valuation is for „$100.00 or less).
() I �h performance of the work for whichrtti� s eI rAnit is issued,
cdr �ia'ln
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 of IQiAA We11Ats 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
permlt,.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 StatVaws relating to the building
construction, and hereby' authorize representatives of this City to enter upon the .
above-mentioned property for insp'rtlor�,purposes t
Signature (Owner/Ager
w 444_:4.
"`C"'
BUILDING
ERMIT
P9����1�3
y
_P_ERMIT,
DATE 1111:5/95
VALUATION 5118,107.7(1
~
LOT 19
TA 26152
JOB SITE ADDRESS
APN
r 47-44J'' V A,:�i�GF,J
617-700-(559
OWNER
CONTRACTOR
C.EMPLY,FIOMES CQM"ITIES
CEN'TURY ROME CO'IMMUNITIES
'1535 SOUTH D:1':RLE?'I'1#'200
1535 SOUTH D S'I RE13T 51200
SAN BEIt.AtARRL IN0 CA 92408
SAN I3:F,'.I NARDIN; t. -'A 92Afitl'
DESIGNER/ENGINEER
�����
USE OF PERMIT.;
SO4GLi FAM.11A i� vVELLING
SP1NAIAKFA COVE AT LA QUINPA b
PIAN 31311
FEE DESCRIPTION
FEES
TRAM CONSTTZt tTION 1,943100 SAI"
OARAGFJCAitPOW,,f 0543..00 SF
FSTMAT.E.1D COST OP C'ONSTRUC'T 10,01
118,107.70
PERMIT F E E SUMMARY
.PLAN CKFCK fl -E: 14 (11-Uf )0 439-31 R
CONSTRUCTION FM 101-000-418;.000 $706.00
1v31aCfIAN1CAL Fhb 101 1700-4.21=000 $33.50
k.'E:vT.1UCAL f'E"F 11)1.000AW� 00t1 . . " $1444.37
PLULM8.T Q FEF ? 121-1700-419-000 '$139,50
$TONIC, MOT(ON. M = RESID 100-0100-241400. $11.31 •
-
C:1iAi3INCfI ?ia 101-000423-QO�1 - . $7.0.00
Ctd1Ft2ASfRtJcw'GIJR.EFEE,5-600-443-2142, $2:657.42
PRP,CISF, FI,:a.N !7l-Oi?fl-441-34g.. , - �,rtl)
11kT ,N PIA IC PLACES 701:000-255 000 $45.27
JI
>�o-`I'0T&L 00NISa" UC'[1ON, AND PLAN CHECK
54;392.00
LESS PRE. AID FEES
0.00
410
1 6' 19 1(3 [iAi, PERMIT FEES DUE NOW
54,392.00
RECEIPT ) .1.
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 Zf
Return Air
Steel / p
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 /p
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
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
PEUMBING APPROVALS
1 11
Gas Test
Electric Final
Waste Lines // 0
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
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
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 11/15/95 Type of Permit I La Quinta
No. 13899 Permit #
Log
Owner Name Century Homes: Communities
No. 47.845—Street—Via>Nice __ J
City La Quinta Zip 92253 Study Area
APN # 617-790-019 Tract # 126152 Lot # 19 Square Footage 11943
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 11,943 or $ 3,341.96 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 thisproposed project may now be issued.
r
Fees Paid By. Century Homes Spinnaker Cove,'L.P. Telephone, 909=381-6007
Name on the check
By Dolores A. Ballesteros A
Superintendent
Fee collected /exempted by. Pauline. Pearson
Payment Received
Signature �� Qp;�,�� $3,341.96 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