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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
Licensq is in full force and effect.
t z) 4S1 y"21 113- V96
Lieense # Lic. Glass Exp: D
date /'
Signatureof Contractor
o:°i
, ,hereby affirm that I am exempt frorh th%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).
O 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:
O I have, and .will maintain a certificate of consent to self -insure for workers'
compensation;`gas 'provided for by Section 3700 of the Labor Code, for the
'performance of the work for which this permit is issued.
O 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 hot be completed if the permit valuation is for $100.00 or less).
+e gsr+�;>
( )' I cer tiiat�ir`�'tInt lrformance of the work for whic thls`pe1mit is issued,
`t 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 J3700 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 IrSdVh07allsT&officers, agents and employee"
2. Any permit issued as a result of this application becomes null and void 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 inform til n is '
correct. I agree to comply with all City, and Statte laws relating to the building
construction, and hereby authorize representatives of this City to enter upon.tke_
above-mentioned property for insp , tion purp s. .-
Signature (Owner/Agit)
A`°'
BUILDING PERMIT
PER!;5gii�fw(,
DATE 3.,9IDS,
VALUATION $11 gtsfa2.213 LOT
TRACT 26152 ,
JOB SITE ADDRESS `'sin.. —.
APN
T4(C1-7 *.
61W790-02
OWNER
CONTRACTOR ,
'CENTURYHOMESCOR _431 t:r�ifr-WIS
MMRY HOMES C0N1D1r1 _lPtiMf,..S
15)5 SOUIN O STSEET 1r.00
1535 SOUT14 D KfREFT .6200
SAN BF.RNA.RDIi O CA 9-2409 .
SAN T3EIZNAP DiN' C A 920£4
e��n;���� l:r;Ilm t~lar:i>~ at an
DESIGNER/ENGINEER
(W)3131-4007
USE OF PERMIT F0i,GLE D'=:AJ'i+1D.LY D V F3LLING
4<+ IMNAKER COVE Al' LAKE '.(,AQUIN`1W
PLAID 100
FEE DESCRIPTION
FEES
TRACT CONSTKUC'i ON 19420 -
CrARhOWCARPORT 52i.00 sr"
f
ST11MAT ED COST OF CONSTRUCTI(rN
11
3�I? SAN C if34",1C :t ikk: 103.-000-d39 3I$ aiti.0
C6NSTfttJ4:°L':I0_N F.frE $695.50
: •
fNetiCf3W A1.: FEE101-000-t21-W $54.00 .
1:~'.UC1RICAL FW . �.. 101-000-420.060.. X141.5
. 1r1.;i MJ31A1� �'1<�s 3 0•!-t?,00-41 �>-000• .. $ 333,E
STtiNG MclT16N i�E u R_ESTD 100-000-241-000. $1:.57
G AD.ING FEE- 101wG{ -423-004
1WRASTRUUY KE 19E 225-000-443-342 S?,402:4
,PRJ C]-'% PLAN $25.00
ART x'1MLIC 1:14CRS - RI ESIC "'01-000,255-000 $39.4.6
a43-'TOTA1. CC, NS iRLJMON AND. P1 Xh1 CHECK:
$1,302.65
_ LESS PRE-PAID•i. FEES
$0.00
O:y.16 1995 TQMPERMIT PEES. DUE NOW
$4;302,65
MAL.t O.ID C"i. .RDYiIT Y
-BV'
4,311LOS
RECEIPT
DATE
DATE FlNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
2
Return Air
Steel
c
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F. .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
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
G
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
7 J
Encapsulation
Gas Piping
Gas Test
fibs
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
Utility Notice (Perm)
DESERT SANDS UNIFIED SCHOOL DISTRICT
f 82-879 Highway 111
NOTICE: w Indio, CA 92201_
Document Cannot Be Duplicated6.19-775-3500
Date 111/15/951 Type of Permit La Quinta
No. 113896 Permit #
Log
Owner Name Century Homes Communities
N o . 47935---s-t r e et-V--ia-Nice--
City La Quinta Zip 92253 Study Area 1237
APN # 617-7907022 Tract # 126,152 Lot # 22 Square Footage 1,1942
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 fee's 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- 909-381-76007
Name on the check `? t
By Dolores A. Ball'esteros IL'
Superintendent "a `
«p a
Fee collected /exempted iby Pauline Pearson,
` Payment Received
Signature � J $3 340.24 100754
--4� Check Ne.
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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