9605-101 (AC)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. 9 f
License # Lic. Class Exp. Dad f
Date Signature of Contractor /
OWNER -BUILDER DECLARATION
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:
Carrier Policy No.
a4!`A!liFw F NI) I3'iI4)9��94
(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 bject )o the
workers' compensation laws of California, and agree that if I s Jould become
subject to th workfers' compensation prov`isionsiof S ction 370bbbb of t e Labo
Code, I shat forthwith comply with those, provisions. 7 f
Date: !
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
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
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
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 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 — 7— 6
Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot' Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
. 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/21/96
No.., 14497 Jurisdiction
Owner Name TD Desert Development
No. 79115 Street Via San Clara
R
APN # 649-400-012
La Quinta
Permit #
L")g #
City La Quinta -zip 92253 Study area 123
Tract # 27952-1 Lot # 12 Square Footage 180
Type of Development New Residential Addition vo: 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 -_xempt from paying
` school fees at this time due to the following reason:
-- t Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
' This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.84 - x 180 or $331.20'
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. -
Fees Paid By TD Desert Development ,
`fele hone -
P 771"'1:9,.41
Name on the check"'
.. r 1 •n'. •!`ter
By Dolores A. Ballesteros
r
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $331.20
ti
r
Check No. 1562
Signature t�
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 '