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9603-020 (SFD)r" u/? 'K, LLO T LU � Z' ►� 0 (0 0)J U. W w H a - U) z LICENSED CONTRACTOR DECLARATION J 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 7'1F3A k� fr " • tisl3ll% /Date _ � � Signature of Contractor OWN ER-BUILDER.DECLARATION I hereby affirm under penalty. of perjury that a 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 isnot 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).. ( )' I am exempt under Section ,., B&P.C. for this reason DateSignature of Owner WORKER'S'COMPENSATION DECLARATION I hereby affirm under penalty of :perjury one of -the, following declarations: O I h6e and will maintain a.certificate of consent to:self-insure'for'worker§' compensation, as provided for..by Section' -3700 of the Labor Code -for• the performance ofahe 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: CartierPolicy No. 'U�S1�tC CIVIC WS RAMC` (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 fo`;•the• workers' compensation laws of.California,,and agree'that.if I'shoul6become subject to the -workers compensation provisions of,,Section-370A of the Labor' '. Code, l ` n SII forthwith cor iplywith those; ,provisio s: rr Date: -P 4 Applicant �, • /�" T.P." !' "� .. "�. Warnin .Failure to secure Workers"',—. coverage is unlawful and shall.subject anemployer to criminal penalties and civil fines up•fo $1'00 000Jn addition to,the cost of compensation, amages 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 beFialf;this'application is made & each person at whose. req uest'and for whose'benefit.work Is performed.under-or pursuant.to any permit issued as a result'of this.applicaton agrees"to, & shall;.indemriify & hold harmless the; City of La Ouinta, 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 permff.to cancellation: I certify that have read this application and state that the above information I's correct. I agreeto comply with all City, and. -State laws, relating to the building construction,- and hereby authorize representa�es of this City to'enter upon the above-mentioned'property for­1rspectiortpurp6ses,, Signature (Owner/Age's' PERMIT#.. v ;, BUILDING PERMIT,,:;, 2.958,' 95 DATE VALUATION LOT TRA T. 31096 .. $:14', - ;14) 3 � " �u t�Z Pit qi A. JOB SITE � _ ADDRESS i:�ia[tf :D�s4A�d4-i1i APN OWNER- CONTRACTOR/DESIGNER/ENGINEER c:��NR°(�URYe��tOW r.l.. ;1t�t� tt : ��t.r :- t fa t` � : �Rt� v ,r, ;e� r�rtriott�T:s ... iS so. " " S.['it 1, S`i';fy #200.l S3 So. `"13" :�"1'R f a 4` .11200 SAN LiLRNARlK CA 924 S.A.N F3F:[�NraE2DiN© CA 92408` (N9)."14i007 a949jzg1 A07: • . ''13I;'f 217.0 A.i:F+b�c: USE OF PERMIT SI 'i�Li, ii JZ ' a'w t LING ��6 b:A 1'-C HAPMAN Avg. . C).itANCv F_ CA. Y .tS6S ' ; SPINNAKER COVE �P�,1.:AKE T.A QLIP TA _.. PLAN 413,Ft 5:3AkA.GJrJ 't\9P0.R:I'630.00 V. 'i'R&CIr O0NiTI2,C3C'F.ION ,437.10 Cf% ESTRUM Ca. WN$TRUC 2d�'fi3�[ `"1'* ff81 10:! GO(i•:!!�' 0(1;i $i #tt1,SfS �. f''i►t1CAJf..F-L%,. `10j -l00 -420 -fes fi14"'..1I3 C)RADIN0.14YE MAKI z� JN 1ttLS"i'P1lCMWU i f'KS 27-540413-3-42- N117 7;1AAIIGWil 1 bR " "40J-00042 k-000 VLX14 4LI.10;:1a ;h"3 a .I.01- lr4, 9.11}1 KLt141.4�1t40 t•'f Cs .. S f1�3'.7)t'i' �L f t 3 S'tR t 1� f1C)?J A!'1"i'�1N (kl.l; :°n'-85"' _ �.. y k r, '►5.?. . � ,`}�' LT SS•;P.ft� �'iA,l�`� � EisS: n �t�;f3ff ti R RECEIPT `. DAT J 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 e% Exhaust Fans O.K to Wrap 2 F.A.U. Framing i j Compressor Insulation S i% 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 I 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 712 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) Notice: ' Document Cannot Be Duplicated Date 3/18/96 No. , 14255 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Jurisdiction Owner Name Century Homes Communities • No 47965 Street Via Jardin APN # 643-130-038 La Quinta Permit # Log # City La Quinta Zip 92253 Study Area 123 Tract # Lot # Square Footage 2457 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 ac7essory 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 2,457 or $ 4,226.04 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. Plush ;� Fees Paid By Century Homes/Spinnaker Cove, LP ^-TelepPbne X909-381-6007 Name on the check By Dolores A. Ballesteros i - Superintendent Fee collected /exempted by Pauline Pearson Payment Received $4,226.04 Check No. 101043 Signature P x Q a nn a A At A M Azvl— 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