9603-021 (SFD)LICENSED CONTRACTOR DECLARATION
;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 11 13 t OiM o14
Date fd� ` " Signature of Contractor'"
OWNER -BUILDER DECLARATION
1,
I hereby affirm under penalty of perjury that 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 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:
Cartier UNICAM, INSLI)RAW, Policy No. :�A +ki115► UJ
(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=ould become
subject to the workers' compensation provisions of Section::i= of the Labor
:ellCode, I fiall forthwith comply>th'thoseprovislons. —" "
Date'', ���' r n Applicant
4Warning: 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 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 is 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 � l agree to comply with all City, and; State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for`insp"ection pur oses.
f /
%Signature (Owner/Agent)` Z fy Date,
BUILDINGPERMIT
PERMIT# CONTROL#
DATE •4«:06 VALUATION ' �: ,f1Q1.�.4};i LOT.-
* TRACT152 P11S` 1`
JOB SITE �k � aly i Ca 3�f �4 —
APN 64j-1.30-039
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
('1.;PYi'iIRT CROW F1,1,C"( MTFUS
1 3 ► of F. ''� � � 1: itZ i, ANT 'F. uzoii
i y a {3. ' Fa" �`1'i(1 E~% aTi . is2U{}
SAN AMNI-AR1011 C -A
SAN HERWARDINl) CA. 92408
f W 1' d cid}r}'1
I Willi 1-007 C''13.Czl
l.-A1.f° i c?b ASS4�)C b F
USE OF PERMIT
MW ll," t;A_h1ItA 1. Wfi1,1,IN71i
133, VWii .' (f}A)AdAN AVF
OftAN I r 0A 42%66
SPINNA1{14k (''OVV (.(3? L^V LA. Vf f.C13'T'r�
f"iAN 1("rR
c±ARA,00(''A14'0H'1" 419.0i Illy
TRACT (_'0NNTRtX'_F i_)N 1,94 ?.01) SF
INTIMATE[) CONIT OF CYW'�`TRUCTTON
113,663,00
�H;1Et1V49"�' i�'Jt':� 5�lJR911^1tl1EtY
ART IN er+t7W.< (' })T A(liS'-4E:`i'f1 701 -M0 -?55,.M0
Rel I
C0TJS`J1WC"1'tE)N lell 1,01-00041,8- M,
$033.60
td..laVt'kieA!,1i li 101-M-420-000
'SIZ4.83
MADINO 101.000--423-000
i.s3s)
INk RA5'Ra.tf`"l`f6F?f:FPF n,54100-441-341
XMCUANICAL OE 101-000-421.000
�jt?
PLAN CHECK FEE 101.-000-439YM8
}'F,MN191 W'3 f+-Ei 101.000 -41ST -000
X1.43.00
STONO 1vt()IJON w (;'F _ IMS (D 101,0M.N I AM
511.37
Ut4� 'TN'S'TR UC"`%'t0N AND PLAN CIEMCK'
$4,21.9,19
V (� LESS r.R-P,A.ID FT S
s(00
I'I OTA-, I':1" KIt411T VEFN faC NONNY
'6x,219.'79
MAR 18 196
RECEIPT
DATE
BY,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
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 ,S
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 6
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 7
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral 44Pool
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
Notice: - 82-879 Highway 111
Indio, CA 92201 '
Document Cannot Be Duplicated . 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 3/18/96 APN # 643-130-039
No. 14256 Jurisdiction La Quinta
Owner Name Century Homes Communities Permit #
No. 47995 Street Via Jardin - L•)g #
City La Quinta zip 92253 Study Area 123
Tract # Lot # Square Footage 1942
Type of Development y 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 a(--essory 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, 1,942 or $3,340.24
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:
J,
Fees Paid By' Century Homes/Spinnaker.Cove LP ?Telephone :f9.09-381; 6007 }
Name on the check';, i Ja
By Dolores A. Ballesteros t'
Superintendent �`� ; 1•�- f ._
Fee collected /exempted by Pauline Pearson Payment Received K2,340.24
-
Check No. '101043
Si nature
g j k I QeAA4 V c f Al n�1X�v`
r 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
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