9510-097 (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. r � l 1f31lo6
License # / . Lic jC�dss� _ExP Oate a
Date Signature of Contractor -�, �,,•
I hereby affirm that I am exempt frorri the�CofffFactor'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&PC. 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 seH-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.
() 1 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 ompleted if the permit valuation is for $100.00 or less).
ceN c� N' ` y '�I�nit is issued,
() rtt�atnh� performance of the work for which tf�is p
1 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.
Dater Applicant
Warning: Failure to secure:Workers' Compensation coverage is unlawful and shall•:
subject an employer to criminal penalties .and civil fines up 'to°;$100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
}
IMPORTANT Application is hereby made to the Director of Building and Safety,
_for -a permit_subject to the conditions and. restrictions set forth on his -application.,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of 61a"Whs officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void ifD
Work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days .will subject permit to cancellationlI.
I certify that I have read this application and state that the above informatio' h is
correct. I agree to comply with all City„ ar,nd'Stete�laws relating to the building.
construction, and hereby authorize rep�resent�tives of this City to enter upon`.the
above-mentioned property for inspection` purposes.
Signature (Owner)'gent) / r'' Date
f
. i •. :AS . _ 11t
"`C"
BUILDING PERMIT
PERMIT�S�yr
DATE ivi
VALUATION ) 45siSE/ .ZQ LOTTRACT
26152
JOB SITE ADDRESSAPN
'
47_940, ;'iA cif tC�i
' c)
OWNER -
CONTRACTOR
Cf•��fl�7''t1RY :HOMES COMNPJNff1E$
CEN"MY N.OMES Ct`.+ MUNIT11 5
1535 SC1L",1If D S"M.EE7' #200
1535 SOLYM D S'1° EET 11400
I SAN BEdi JARDINC) CA 92.108
SAN :8EKNA1t.17gN� CA. 92408
1-6007 90
DESIGNERIENGINEER
i
(90w)381-6007
USE OF PERAO 7 NV'LE FAMILY D Yir"ELL1r%'1rG
SPINNAKER COVE AT LAK13 LA, Q1I1[MA"
PLAN 10CR2
FEE DESCRIPTION
FEES
`D'kACT CaNSTRUCTION '1,%2.00.3F
CARACIVO l PORT Sig'
F�.19TIMATED COST OF 0ONSTRUCTIO .
1 ,51662.20
. RMrf FEE SUMMARY
PD." CF.i,(;CK rc.E 101=000.439-318 5579.463
CONS'fIUMION ,I7b9 101:-000418-000 $695.50
MM—HANICAL IT, 101-0130--421-000 $54.00
gLF(-,MIC.AL FTE 101.-000420-000 5,641:89
PLUM -1 IJ4`Q 3R'E IOI-000-419-000 $133.50
T�lG MOtION FEW - hSSID 100-000-241"000 $11,37
GkAt7j;�rGf9F_- 101-M423400
TIVRAS'1'RUC7UME-3' 1".0, 225-0(30-443-342 $2,602.A0
PRFCDSF 1?!Is ca W .191-000-441-345 $Z15.(1(a
ART IN PUBLIC PLACES -• RESW 701'0()0-255-000 $39,16
SUB -TOTAL WNISTR rGnON AND PLAN CHECK
$4,302.65
LESS PRG-PAIi) .1 Ei S
$0.00
NOV 1 TOTALTOTALPE:E A11T.FEES DUENOW
6;-1995
$4,302.65
19gs
TOTAL 11.RyyRC RI[rYE.RS
4,301.&5 ,3 1.&5
RECEIPT
DATE ;
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/f1/40vS7_ 4Underground
Ducts
Forms & Footings
9
Ducts
Slab Grade
2
Return Air
Steel
Combustion Air
Roof Deck
2
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
Drywall - Int. Lath
G
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
41
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:
-
:.J
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. 13895 Permit 01.
Log
Owner Name Century Homes Communites
No. x47940—street V Nice
-�-
city La Quinta Zip 92253"` Study Area 123
APN # 617-790-026 Tract # 126152 Lot # 26 Square Footage 11942
Type of Development Single Family Residence No. of units 1�
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 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"331-6007
Name on the check t•a
By Dolores A. Ballesteros
Superintendent f }`J{ f
Fee collected /exempted by Pauline Pearson
Payment Received
Signature U A, Lip LAZA pyy� $3,340.24 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
A