9603-022 (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
CV W Professionals Code, and my License is in full force and effect.
O Z) C') License # Lic. Class Exp. Date,
I• () rn 7 4188 B NY-J07
T
Z r- ` 'DateCD 0 14/r� Signature of Contractor` V
OWNER-BUILDEWDEC 'ARATION
LLI LU I hereby affirm under penalty of perju y1hat l am exempt from the Contractor's
License Law for the following reason:='
Z ( ) 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).
co O I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
O)
Q WORKER'S COMPENSATION DECLARATION
p Z I hereby affirm under penalty of .perjury one of the following declarations:
p () 1 have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
id Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
0 Z permit is u Y�ed Mlyttwor sts'' compensation pensation insurance carr&S&Ip�yic�no: are:
Cartier Policy No.
oob 0
C)
J
(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 agre?, a if I should become
subject to th workers' compensation provisions h L
Section 3700�ef-tabor
Code, 1•sh�a Orth ith comply with those revisions.
Date: `y (1�Applicant�
Warning: Failure to secure Wor3pFs 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 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 Stat laws relating -6 the building
construction, and hereby authorize,eepres`entatroes f -tris City to enter upon
the above-mentioned property,for inspectlon� r oses.
-",Signature (Owner/Agent)'''Z,' ' Date
96tl3rU��
BUILDING PERMIT PERMT# °°NTR°`"
DATE :3/1/96 VALUATION 5145,163.313 LOT TRAC�IS2 }��'Irc«W . SS
JOB SITS
ADDRESOWNER
APN 64X130-040
CONTRACTOR/DESIGNER/ENGINEER
CXW1. UN C It.t7Wl, LL ('_O;�1ti UN1TIM
CF.WLT Y C'l OWE.LL t`.C�AIMUNi`1 ES
1535 SCI, "l)" smk:EEm, `V-1' . 4200,
15.15 Ski. "b" S :MF I'S'f E. P,200
SAID AERNARDIN, CA 924OR
SAN E.3ERNARDTNC1 CA 924OX
(PN)381-6007
.
(W)381 -6W-1 C`.1AC.1+ 21120
I' (;QNL, kLa, & ASS(XIATE
USE OF PERMIT
SIN01111:' FA.MILYLW1';tJINCi
1.0-6,EAJ%TC'4bAl4'fVtAN AVE
ORA1NOR ('A 41466
"PIONAF:TT "tdVf; (ffi 1,AKE LA QUINTA
Pfi-AN ,1A
(911I�AC tli.;rlfLl'l�K!' 63000 S
TR At" T. rp0N..TrRI,1('11t N 2,457.00 SF
ii;S`C11ViA'i ED COSI' X11+ MNSTRETCTION
145,763.10
PE'RNI fIT N'FF SfjN MAkY
ART fN PiTttLIC PLACYS - RC3TD '!0I -0131)-x55_(" $14 4'1
C )NS'TTi.I:ll..'T OINIFRE 1..01 -WO -•113-000 $"800.V
ELEC'1'#t.ICAL rfrf;. 101-M-420-004 $147. tO
MA1:?OW r FEE 101-M-423000 520.00
1r1Ff2!lS't'RItC: t ttltl f lt4 25�E 4- I4?-? ? 31)?'19.67
MFC MANIC AL FNE 101-0011-42140 $73.00
.
PLAN C'RE 'K i -HE, lot -M -439-M8 -M8 x669.:0
PLCEN1H4IN(J Ft_1; 101-000-419-000
'S'fONCYMOTtONt-FEw:RESID I01400(12)4144 344°55
L_' J,` '1'!U(.;'17Qie ,ANll P1 . 3 C HEC'k
$.4,21125, 71
LESS PRIE-PAIDURS
1�� ;�>ta° >� >«ta NOWss,r
Vit!
-moo:
RECEIPT
DATE
BY
DATE FIN ALED
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 ,sAF
F.A.U.
Framing i
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
DrVall - Int. Lath
G
Final
Final
BLOCKWALL ROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I 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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL XOPROVALS
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)
COMMENTS:
Desert Sands Unified School District
Notice: 82-879 Highway. 111 f
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE _
Date, 3/18/96 •APN # 643-130-040 '
No. 14257 Jurisdiction ` La Quints
Owner Name Century Homes Communities Permit # k
R No. 47970 Street Via Jardin L:)g #
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 ac�,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 < .
53080d
Coe
. This certifies that school facility fees imposed pursuant to Government_
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.}�kg
"J, `
Fees Paid By Century Homes/Spinnaker. Cove LP . Telephone' 909-381 `,6007
Name on the check
By Dolores A. Ballesteros
Superintendent `� E;r ; r �. `«•^
Fee collected /exempted by Pauline Pearson Payment Received $4,226.04
Check No. 101043
Signature (Dty �, �, n 1� , Q �1� .t �i9�►,�
Collector: Attach a copy of county or city plan check application form to district copy for all wavers.
Embossed Original- Building Dept./Applicant Copy Applicant/Receipt Copy -«Accounting