9510-099 (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. „, f, � ,
�1`'.icf.'7 13 1.flatF4t�
License # Lic. ass ;%•. Exp: Dates•'
Date &/Signatureof Contractor 56��
AIX, .�
AIX,
OWNER -BUILD ECLARATION-
I hereby affirm that I am exempt from the/(C&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
contractors to construct the project (Sec. 7044, Business & Professionals Code).
O 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 be completed if the permit valuation is: for $100.00 or less):
() I certl�y{ifiai iif`�i t v4 rformance of the work for which tf 100 mit 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,thela' bor 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 persor4on 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 resu�of this application agrees to, & shall,• indemnify
& hold harmless the City of IhdikWellaits officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void _i_ fes,
work is notcommenced 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 bwldingil
construction, and hereby authorize representatives f this City to enter upon the
above-mentioned property for inspection purposes:
Signature (Owner/Agent)X�'" - Date . •T.
ALCM v,:f. #
_ :
�= .., BUILDING
PERMIT,
PERMIT,
.1,, 099
DATE��s
VALUATION c+t1.7.1�
LOT—
�•���
JOB SITE ADDRESS
S
APN
474-�Xr��1MUCpi1
617-79"28OWNER
CONTRACTOR
CENTf.JRY BOM► S C>QMN'it. KIFI1El
:;Dl'I' P1,Y 1HGh f,,S CO'A11N.1(JRTt°1' .CM
1.535 SO€ TH J ST kEq.T €f200
1533 SGUTR D S1,'RC-FT H200
SAN.BriWIJARD1NO CA 92,408
SAN 8E NAR17IN CA' 92401
((9)0YM1.6M)7 n r,a ;I'm
DESIGNER/ENGINEER
„ (909)3 1-6007
USE OF PERMIT,Iii1GsI,E FAIVI(Il AP I)XVIUMING
�+P.1°AtNs KFA C UVE A;1 LAKE 1,A. QfiftJT,�
PLAN 4QLCR
FEE DESCRIPTION
FEES
'CRACT CONSTIOUG110N 3,104.0 SN
�#1 FIC; CA42Pt st2'C 630.00 SF .
f . ES l EM.A. l !' ) COiiST OF C4.11Z3-STr3 U i OAN
PERMIT F10 318"JMMARi'
r?t AN CMCK FKRJ 0:-tltla-a39-31 �3 s t .si
` CONSTRUCI Nt3x FtE 101-0W418-000 8923,00
M11-CHA:NICAT.-H 101-000-423.-000 $92.00
inty:EC'I'R1t,CA�i+.�+FEE 101-000-420-00. S184.74•
.
L$18,09
S't'i, NG i OT -10M' U. - RESID i0MW241-000
GW> Ntx F 101-700-423-1)00 10.00
tr A�� R.t>c tai FES215-000-443-34.2
ART 1Npusuc3' xa-s - R'"-sw, 701-000-2-58-300
SUB -TOTAL CONSfRUICt ION AND PLAN CHECK
LEESS PRF PAID FPE,%
TOTAL PEAKIT FEES DUE NOW
V 16 1995 ^O
�� ®: i ;<� � s
6,45:1:2..1
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
Q
Return Air
Steel
Combustion Air
Roof DeckExhaust
Fans
O.K. to Wrap
4 7
F.A.U.
Framing
Compressor
Insulation
j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/
Drywall - Int. Lath
Final
Final1.4
POOLS - SPAS
BLOCKWALL
APPROVA S
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
COMMENTS:
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 3 ��
Utility Notice (Perm)
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 1 619-775-3500
Date 11/15/95 . Type of Permit I La Quinta
No. 13893 Permit #
Log
Owner Name Century Homes Communities
No. 47880_ _Street Via Nice-
City La Quinta 'Zip 92253 Study Area 123
APN # 617-790-028 Tract # 126152 Lot # 28 Square Footage 13104
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 3104 or $ 5,338.88 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
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature Da x x Q s.�n � PAAkAA_A-✓`-_
Tele -ph ine '-9097-
41
-909-
r #J_
Payment Received
$5,338.88 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
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