9803-123 (SFD)Q► rLICENSED 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
.License # , Lic. Class Exp:'Date
Fir t0r :1./99
J� r
,/Date Signatur .of -CAM% ctor � r
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 th'e'-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).. . ' J
( ) . I, as owner of the property, am exclusively. contracting with licensed
contractors to construct the project (Sec. 7044;'Business & Professionals' .
Code). -
O 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:
O I have and will maintaina 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.
ZENJI14INS. CO. -20669.02
(This section need not be completed if the permit valuation is for $100.00 or less).
' ( ) -1 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 should become
subject tote wor ers' compensation provisions of Secti' n 3700 of the Labor
Code, -II fort it comply With t ose,prionsd
,bate: �� Applicant ry-^
r i
Warning: Failure to secure Workers' Compensation Lcoverage 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 herebymade 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 4 .
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 cap ce lla i�n rp
I'certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building i
construction; and hereby authorize' represintatives of this City to enter upon i
the(above-mentioned property f spection p oses 1 `�� t
-fS gnature [Owner/An ew*'' `bate
M1' BUILDING PERMIT PERMITN ;^ r CONTROL#
DATE VALUATION LOT —�'•" TRACT'
yp
$90,909.50
JOB SITE ..w-.,r.,,y, 'r,.w,,...«-•..w,r—�s'�^-.^''
ADDRESS ' _�% c�.6Li:.U$3.Y'v ��:
APN
OWNER -
CONTRACTOR/DESIGNER/ENGINEER.
C.,`.ENF1'tTP,Y CROWELL OOhgMUNrI'1ES ..
ClaNll!RY CROWELL, CONIMUNIT"'Es
1535 'S J.' "I3" S'I'K8,Fr, SM, i#200
035 S."o "'D'I STREET, SFE. #200 .
SAN BE,RNARDINO; CA 9240x3
SAN BERNARDINO . Cil 92405
-4
r
f9A j;3 i-oi1G+7 a�t3L' 2120
USE OF PERMIT "•
tilata . '• ..
,
PLAN 3A - S.l ll = DF1, t2i 3' �T LA Svi7 tJ t A. Nogg- - %Is PLA.Ai cf,*_ d°N
REDUCTION APPLIED'
TRA, '''r CONSTRUCT1O1V 1,445.00 8
0A1bV3EJCARP0RI' 63y.0fi SF
CST a:Ri�t $+�.. D COST OF COINSt f� 3eI1+�.`'$":9`ON
90,91 �9,50
PERMIT FEE $'ifM•j1 ARY
LAN CHta'CK r8E 101.000-439-.318 $701.98
CONSTRUC1`.ION.1-EE 101-0004118-000' S4f3�.Ot)
N IEC ANICA'f;; FEE 10:1-000-421-f)t1t1 19. D
tJst CVRK,AL PEP - t0.1-000-420-000 $111.78
PLUMBING FEF ` i:01•Q(1()-n19-OQO..__ $118:00
.=?'r.R.ONG M0110NEQ -, RESID 101-000-241.,000 " $9.0
r"t .ltlt.FEE -' -0 1:01-000-423-000$20,00
TN_FR ASTRUC'WRE• FEIR 2'25-i306-441-:3- 2: $y:045 46
f t�LAN cxJz_c K.n_-.E 7 4379.7 3
"
K h
.:.. ••--� ri
—� sr, S1`u itlL Ct7NSl1Zl1CsTIUId AN131SL1lld CHECK
$3,48531
L13SS _PIZE-PA.I1J : EE1
437 t33
'JUL
,
TOTAL PERMIT FEES ES DUE N04V
RECEIPT
DATE1(r BY #,
DATE FINALED
INSPECTOR
$jz4
t II
,
• a
• i
Y•
t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
04 a,-s—Ducts
Slab Grade
r--
Return Air
Steel
Combustion Air
Roof Deck
— B
Exhaust Fans
O.K to Wrap
Z -/0 ,
F.R.U.
Framing
IA -17- Q ,
Compressor
Insulation
_ Z� . �j� X
Vents
Fireplace P.L.
Grills .
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines _
Party Wall Firewall
Exterior Lath
2,r P,','Drywall
- Int. Lath
Final
Final
BLOCKWALL APPROVA S
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
— 6 —
Heater. Final
Water Piping
Plumbing Final
Plumbing Top Out ..
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
O -—Q
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
t
Final
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
• 1 47-950 Dune Palms Road
Notice: -
• - La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515 1'
' CERTIFICATE OF COMPLIANCE
Date 7/22/98 APN # 604-373-006
No. 17379 A `r Jurisdiction La Quinta l
Owner NameCentury Crowell Communities Permit #
No. 79-145 Street Victoria Drive Log
City La Quinta zip 92253 Study Area
AI
Trict # Lot # Square Footage 1;445 ,
Type of Development Single Family. Reside rice No.'of Units 1
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 iccessoryatructures or replacement mobilehomes.',
It -has been determined the above-named.owner is exempt from paying school fees at this time due to the following
z. reason: r ; r
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant,to Government Code 53080'. i! qui ti F ,amount of
ry �
1.93 , X 1,445or $ 2,788.85 the property listed above and that buildmg% `
o
perm its, and/or Certificates of Occupancy; for this square footage in this proposed p ject may nowbe issu��edr*
Fees Paid By CC/Foothill Independent Bank/Ed Knight Telephone y909 381_0041
Name on the check ,•
By Dr. Doris Wilson
Superintendent '
Fee collected /exempted by Juanita Green Payment Received $2,788.85
Check No. 604539.
s Signature
NOTICE: Pursuant at embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified-
above will begin to ru om the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized,to
collect them on the Dislrict('s)(s) behalf, whichever is earlier.
Collector: Attach a'copy of county or city plan check application form to district copy for all waivers. 'ty.
. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting