9605-029 (SFD)4:
17-UldENSED CONTRACTOR DECLARATION,
U). *eby affirm under penalty of perjury that 1. am licensed under provisions of
U) CKapter 9.(commencing with Section
.7000) of Division 3 of the Business and
C\J LU Proifessidnals C6de, and my License is in full force and effect.
0 Z) License# Lic. Class Exp.. bate
W T I"S8
Af
Z Date /11 ---8ignature :of Contractor""
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_J 0, 'OWNER -BUILDER
W W I hereby affirm under'penalty`bilperjLiry thd I am exempt from the Contractor's:F- a--
License Law for the following reason:
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1z 1, as owner of the pfoperty,;or my.,ernployees'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 property, Am, &xdlU6FVelY•d6hti`AdtR)g W1111 IlCel),W1
contractors to construct the project (Sec. 7044, Business &. Professionals
Code).
)'.I am exempt uncle'r Section B
&RC for this -reason
LID
C\1 C\1 Date Signat6r6 of OWh6r
01
0
z• WORKER'S COMPENSATION DECLARATION
C:> -
I he I re . by affirm . ni under penalty of perjury ne
cr rJ Y o :o h [owing decliraiicins:
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+- 0 1 have and.will maintain a Certificate of consent to self-ins'ure for workers'
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'i'X W. compensation,, as,orovided -for by Section 3700 of the -Labor Code, for the
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performance of the work for which this permit is issued.
have and will maintain workers' compensation insurance, as required b�,
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LoSection 3700 of the Labor Code, for the performance of the work for which,this
.
permit is issued. My, workers' compensatioh insurance'. carrier &, policy no are:
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Carrier - Policy No.
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< (This section need not be completed if the permit valuation is for:$10q.00 or less).
"_J 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'tfie
workers' compensation laws of California, -and agree jhat..if I sh6uld-Se�ome
subject toW rkers' cornpeinsation'provisi6ris of: Section,3700of 1he. Labor.
Code;a-shallsfowith comply with'those'Orovision,
Date
LCeApplicant
W
ar to s6duie�Workers'. Corpe,, sa on coverage is unlawful, and
shall subject an employer to.aimh Pies a 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 an(!�attorney's,fees.
IMPORTANT Application I-Srhereby 'made to the Director of'136ilcling and Safety
for a : permit subject to the c6nditions.and restrictions set forth :.on his ti
application.
_1 Each person upon whose behalf this ao Olication is made & each p e rsi'dn' " at
whose request.and for whose b6neifit'work is performed uhd6r.*o'r pumuaht'to
any permit issuedas- a result of this applicaton-a4rees to, -&-shall,; indemnify
& hold harmless the. City of La Quinta, its officers, agents i and.employeesL
'2:.Any P' rmit'issued as a result of this application become5-null.'and void if
work is not commenced- 'within 180 days from date of issuance of,'Such
permit, or cessation of work.fo+r 180 days Will, subject permit to'dan6ellation.
I certify that I have read this application and state that the above, information- is
• correct.) agree to comply with all. City, and State -laws.'relating to the, buildin g
construction; and hereby author 3s,'6f this City.toe t,er,pon,
the abo've-me;'ntioned 0roperty:for inspec iog,.purposes.
Signature. (Owner/Agent) bate
4E Z L -"e-'!
PERMIT# CONTROL#
BUILDING PERMIT
DATE VA"ILUATION LOT: TFIA'�CITDII 41J)4,3290
ts
JOB SITE
V�
ADDRESS WX
AP14
643410-032
'OWNER
CONTRACTOR/DESIGNER/ENGINEER
C.*F.,Nf,LIK),.?'.(7,ItOW','x,I.-,I, co-mmownut;
�-aitqYrum. Y_ oaomlr..�,,j, comMUNUM S -
A 535:80. 7,0!' 9M8.0 r,.,qTE, #2001
-ROARDIN-' C.A.CA .9�,409
SANT BFAY.
C og-
-SUR.NARM C A 924
,007.
.:(909) C1.1211. 2120.,
USE OF PERMIT
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om rksr CAP,`%N AVE,
,�FWJAKER.COVE OILAKE L (46NTAr
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TRAC-T (XYNSIVJC110N S'F
GAIMOIRICARPOW"r 41.7.00 '14F
ST IMATEO'Cl0s, CONtI.S.r
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1191976MI
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CYNSTRLTCTION 'Fr% .101-0041.3-000 G9._5o
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MrOlIANW,AL f11T-' -it .0 lo
0_000
C I f _"o two, 1". k 0 �4 mtf RV,� T D 1.6 1,400-.2414010 % 00
WPL9 T .1 It, Ro P, .000, 149.94
C %A1.10C ION A1,1 UP CT X
s0o; rol, if rM, "T 'LAN &C
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TOTAL PERM UT ME$- OVE NOW
M A
RECEIPT
.1DATE
BY
.11
DATE FINALED
JINSPECTOR -- -----------
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
IJ
Underground Ducts
Forms & Footings
Ducts
Slab Grade
v
Return Air
Steel
Combustion Air
Roof Deck
(j /
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
7
Drywall - Int. Lath
if /
Final
Final
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POOLS - SPAS
BLOCKWALL
APPROVAIS
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
Zp
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
W
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 w -
Not e: 82-879 Highway 111 -
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/3/96 r APN # 643-130-032
14436 • �"..
No. Jurisdiction La Quints `
Owner Name Century Crowell Communities '• Pe. -mit #Y
No. 47785 'Street Via Jardin Log #
City La Quints Zip 92253 Study Area' 123'.
Tract # Lot # Square Footage 2059
Type of Development, Single Family Residence No. of Units
At the present time, the Desert Sands'Unified•School District does not collect feed 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 2,059 or $3,541.48
r 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.
Y
Fees Paid By Century Crowell Communities Spinnaker LP Telephone909`x;81-6007
Name on the check
• y,
By Dolores A. Ballesteros
Superintendent# { r
Fee collected /exempted by Pauline Pearson' Payment Received r `$3;541.`48 ' ,a
Check No. ' 102314
Signature
Collector: Attach a copy.of county or city plan check application form to district copy for all wE.ivers.
«� Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting