9510-094 (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 Professions Code, and my
License is in full force and effect.) �t/ j ✓�'-n,,/�1/�liQ�i
License # Lic. as
Date ✓ /l Signatureofl,ontractor !tea''
0
OWNER-131.11111�C: ION
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 wilb•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 be.completed if the. permit valuation is for $100.00 or, less).
() I cer�Ify(t�iAV °theVperformance of the work for whichtthis permit 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 `
f 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-.
amages- 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
fora 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-'-
Y whose request and for whose benefit work is performed under or pu[suant to
any permit issued as a result pf this application agrees to, &. shall , indemnify
& hold harmless the City of (4d&00ilss, 4g officers, agents and employees.
2. Any permit issued as a result of this application becomes null and vol 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 cancellatioot
I Certify that I have read this application and state that the above information16-
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 inspe%cbjposes.
Signature' (Owner/Ager. �y�',r Date.
ALC '
BUILDING PERMIT
PERMITi
DATE ��
VALUATION iLOT TRACT�SZ
JOB SITE ADDRESSAPN
74 t o N>rr ;
617-79W)-020
OWNER
CONTRACTOR
Gr,�,i VRY I�iOMMS CL'1�A�iM[.�, YrfES
1.535 SOUTH D STR,Eff, x,200
153 5 90LU ri EI S`1'REET 0200
SAN BERNFARDIiNO CA 92405
SAN BER.NAPLEIK CA 92408
.&V)7 rtaf #1 717n
DESIGNER/ENGINEER
(M90st-6+007
USE OF PERMI 1NGLE FA;b1IL Y DWELLING
SPINNAKER COVE AT LAKE LA QiJli� i'A
PLAN40A
FEE DESCRIPTION
FEES
TRftCT GT_Y lS'.rRf,1CTYiJN 474100 V.
CARA.�►FJCt1,12 OR'i 630.00 Sr,
ESTIMATED COST OF CONSTRUCrION
161,184.jo
PERMIT EEE' STJ.MMARY
TLAN CWCKflffi $719.85
CON; I'MCTIONFEE 10i-00041.8.000 $1346,50
MECY"ICAL FEE I01 -D I)^�32_i.-{Df� $f39.3Q
I LEC"%; UCAL M 1.01000-420.000
' :[.Ii3Yi+i'Ci I'" i01-f3f30-4'1>�r(}Q0 $k6.�.th�
STOAT•TN10T10NTF1,FX--RESID IQD-000441:000 �1G.Y2
GRADINOU FM VU()
TNFRAS T t IXTURE M, 225 -M -443-34P.
MI' iv :PUBLIC MACES - RESY13 70 -0W255-000
®rSr t1L CONS'�°1tf�l-'" 10N AND PLjVN' i1 -1I CK
$5,321.44
# .. ` LESS PRE -PAID FEES
10V1 g 1995
$O.W
f
Tib'AlL-FERWTFEES DUE NONN .
RECEIPT
DATE'
BY
DATE FINALED
INSPECTOR
` 'INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
e)A,4
Underground Ducts
Forms & Footings
of
Ducts
Slab Grade
/
Return Air
Steel
Combustion Air
Roof Deck
9(,
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 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
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 La Quinta
No. 13898 Permit #
Log
Owner Name Century Homes Communities
No. 4%t5%5 Street _ Via Nice" —'-
City La Quinta Zip 92253 Study Area 123
APN # 617-790-020 Tract # 126152 Lot,#= Square Footage 12741
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 2 741 or $ -4,714.52 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 909-381-6007
Name on the check *a -X. r
By Dolores A. Ballesteros;
Superintendent g�
v
Fee collected /exempted by Pauline Pearson
Payment Received
Signature $4,714.52 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/geceipt Copy - Accounting