9601-124 (AR)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
:'_icense-is in full force and effect. 314473 a 1/31f46
License # Lic. Class . Exp. Date
DaDate i SignatureofContractor
✓'`%,�"� '"'-
K'.
OWNER-BUI DEC 'TIO
I hereby affirm that I am exempt? orn th ntractor's License Law for the
following reason: %
() I, as owner of the property, or rSiy 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).
( ) 1, as owner of the r 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 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 i�%i�Vi'01d.AL I dS . Policy No. VC'19261A
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of the work for which this 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 pro5i6fons of. Section 3700 of the Labor
Code,..1 shall forthwith comply with thhse pr9y,j q' . S: -`"
,��`'�
Warning: Failure to secured ork� ompensatiorncoverage is unlawful and shall
subject an employer t6 criro(fnal 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 Indian Wells, its 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
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 building
construction, and hereby authorize rept�tives of this City to enter upon the
above-mentioned property for insp66tion.purposes. }
Signature (Owner/Ager1)) pp// ✓� �� DabBl
F;^
ALC M
_B.U:ILDING PERMIT
PERMIT
DATE ; :�. ` ' to
VALUATION e` "� �•+�
LOT TRACT L
JOB SITE ADDRESS 47-940 VIA 01RENZE
APN
11.
OWNER
CONTRACTOR
C,n�N'1'i.}•12:i'' F•ft,�Mt,� ��t`1)4f'Aff 1iJ1 f°t}.ti
CI:N T'URY H� MES COM.l3I'L.rNPi'i.ES
.: 15-15 5011 fl!
i 535 sourH L S'i't2m f# oo
&UNI BERNAEiDINO CA 92408
B1vKNAF IINi CA 512408
(909)-191-6007 CF3 0 2120
fSA:N
�q1>1 ��jf1(i i
DESIGNER/ENGINEER
USE OF PERMIT\ TJ
FEE DESCRIPTION
FEES
tSLJivI)`N FCUVlVx .L1i.W) St'
x
i "ITI l�'l'k 91D COS Of' CONSTRUCTION
`
V1;JHMIT Ii+E1 SIUMVI RY
PLAN C'11FMFUE 101-000-439-3.113 $605.
.ON�STT2�JC'1'10N 1;U 101-0J0-�!18,O)0
•iti} 8CHA XI.CAL F913.1 :101-000421-0()0 $15.04
Y%1 C,,TR CAL ME, 101:-000-420.000 $` 2.53
P1 U1bf13'INq FFC J014)0-419•000
5'i'd?ING i�3C��'i1o3� FEE -= k .SM I.00•-000-2 14 $,77
11 �}FRASTRUC'UIZisRM 2'25-00G443-342 $168.97
SUPS-TOTM,. (:'t3NSTR.UCTIONAND. PLAN CHECK
$:370.52.
.. TOTA14 PlilitillH �FE..&S DUENOW
U70.5Z
y
7995;, f
RECEIPT
DATE a:
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
Return Air
Steel
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
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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 Piaster
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
Utility Notice (Perm)
Desert Sands Unified School District
' Nohice• 82-879Highway 111 •' r '� . ,
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/7/96 APN # 617-790=014,
No. 14120 Jurisdiction La Quinta
Owner Name Century Homes Permit #
No. 47-840 Street Via Firenze L.)g #
City. La. Quinta Zip 92253 Study Area 123
Tract # 26152 Lot # 14 Square Footage 215
Type of Development New Residential Addition 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 aczessory 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 215 or $ 369.80
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 ByCentury Homes Spinnaker Cove, .1
564 5' ,
J G.-
Name on the check
3
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $669..80
Check No. 100986
Signature EM A G . »I A I A A ,CSS
Collector: Attach a copy of county or city plan checkapplication form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy 7 Applicant/Receipt Copy - Accounting