9605-031 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury 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.
License _# Lic. Class Exp. Date
l 1`r1119811_s3 _.,� w/��d�3 E
%��
Date _ Signature of Contractor
OWNER-BUILDER'D�EC�L'ARATION
I hereby affirm under penalty of perjury.taFi t 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 Oe6pcsfty, AM exclusively contracting wnn wensea
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 V3NI H, rNS. CO. Policy No. 2" 206690
(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 provis�ns of Sec on,3700 of the Labor,
Code, I shall forthwith comply .with those provisions
Date: A- I�A Applicant—
Warning:
pplicant Warning: Failure to secure Workers' C.o.nf p s or coverage is unlawful and
shall subject an employer to crimin fFe' an civil fines up to $100,000, in
addition to the cost of compensatio mages 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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, 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 representatiygs'of this City to enter upon
the above-mentioned property for inspection, purposes.
Signature (Owner/Agent) Date L,'�i�/
PERMIT# CONTROL#BUILDINGPERMI�
N W96 $161,18Ar30 I 0`92
DATE VALUATION LOT TRACP
JOB SITE �1r
APN 33 ,
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
t".ENTURY CKOWE . L COhl MlJfIUM1•
ti..EN11IRY CRO :4fELL COIN ">rlt,tNMES
1335 'S,0. r,D' :1 1r , AK.M.'11200
rsftyi m "W srRF. ~r, ,3,rE. mo
ti,-A,N SERNA1ROIN, CA 92408
SAN BERNA.11.MNO CA. 9140$
4'V).1391-6007
(90q)381 W07 C1301 2720
r r" - I per• `" •{'.tVVPwl1k,i1V(,.MArr1;.94Sb ASSOC.H,�l.iJlJ
USE OF PERMIT
fSINULE'MNLlLY DWELLING
133%EATrC14APNIANAVE.
i'1'A 1.K 9
SPINNAKER COVE 0, LAKE LA. Q, '1 IJINt� b.,... .
PLAN 40B
IRA.CrCONSTY.UC'iI N 21741M SI,
CAR alG&CARr' owr 6XW SFr
i?S TIMNI'V) COSH' OFCONISTRUCUON 161,184.341
PERIL rf FEE SUUiNIN Y
PL A:N (.IF. WK F17T $711.
COINS 'I UC1`lviv F 101-000-41$3-000 SSg6.50
N13 -J' HANICAL EE1.01-000-101-000 S79.(ro
.1.01-000-420-000
i't,tffl4F)t140FFIE, ?(31t( )Q 41®-tlt)0 41.�I xS
M101 Ci401,110N.F. RESI.1.'r 101-000.241-000 S16J2
ORA01NO t LIJ, 101-000-423-0W $20,00
TNF A8T17.t;?("1`i I1kP' ±FT-, '225-000-44K4-342 $3,626.65
j RT tN PUBLIC P CT!� :1113S t: 70-1-(►i3!I-25!i4YR) $152.96
..._.,ttrTnalc T�LCCa l PLAN CHECK $5,78114
I.XSS FRE-PAir) FEES $0,N)
( Lj
' � TO' � �'ER.i!'ff FRES DUE NOWNOW$5,781.24
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i
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
2
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX 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
/l1
Drywall - Int. Lath
30
Final
Final
POOLS - SPAS
BLOCKWALL
APPROV LS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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 -Vizm
A4
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 ,
Noti : 82-879 Highway 111
Indio, CA 92201 `
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF'COMPLIANCE
Date
5/3/96 0 APN # 643=130-046
No.' 14438 Jurisdiction 'La Quinta
t 7
Owner Name Century Crowell Communities Permit #"
4,7 740 No. 0 Street Via Jardin .Log # -
'1 City, La Quinta zip 92253 Study Area ".123
Tract # Lot # Square Footage 2741
Type of Development , Single Family Residence No. of Units 1
Comments
M
Y
At the present time, the Desert Sands Unified School District does not collect fees on garages/carport"s,
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 froni,p' aymg
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 f
in the amount of 1.72 x 2,741 or $ 4,714.52
the property listed above and that building permits and/or Certificates of Occupancy for t. '
• this square footage in this proposed project may now be issued.
Fees Paid By Century Crowell Communities Spinnaker Cove LP Telephone 9.09='M-6007%
Name on the check ,•.y {
By Dolores A. Ballesteros p
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $x;714:52
Check No: 102314
Signature \ A4i , 1 Mp. P-9 PVr'n A JZ� -
1pCollector: Attach a copy of county or city plan.check application form to district copy for all waivers..
r
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting