9803-122 (SFD)LICENSED CONTRACTOR DECLARATION..
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11 hereby affirm under penalty of perjury that I am licensed under provlsions.of
F6" Chapter 9"(commencing with Sectlon-7000) of Division 3 of the. Business and
i14 ,w Professionals Code, and my License is in.full force and effect. "
OLicense # r Lia Class '. Exp. Date
�. Z t -`Date" �dM1 Signature of Cont actor.
c� O: r
r"
OWNER-BUco ILDER;DECLARATION
"
Lu LU, I hereby affirm under penalty of perju'ry'thai I am exempt'from the Contractor's
1 ~.a License Law for the following reason:
(•.) { 1,,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
r=' sale_(Sec. 7044, Business& Professionals Code).
I, as owner of the property, am exclusively'contracting-with licensed
_contractors to constructthe project (Sec. 7044' Business &Professionals
Code).
CY) O I am exempt under Section B&P.C; for this reason
LO
N Date:' r - Signature of Owner
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Q WORKER'S COMPENSATION DECLARATION; >'
O > 1 hereby affirm• under penalty of perjury one of the following declarations:
Lo F" p O; I have and will maintain a certificate of consent to self -insure•for workers'
X LU L—L . compensation, as -provided for by Section 3700 of the Labor Code, for the
J Q performance of the work for which this permit,is issued. .
I have and will maintain workers' compensation insurance, as required by
0110. Q Section 3700 of the' Labor Code, forthe performance of the work for which this
ra oLf))F ,permit is issued. My'workers'.compensation insurance carrier & policy no: are: _
?'>Z Carrier
,.•- r at+iePolicy No.
00 c'.
(9i'1%w 4rJ1.13. r04,020
(This:section need. not be completed if the permit valuation is for $100.00 or less).
w it 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 Califo�rr a,, and agree that if I should become
subject t the w8rkgrs' compensat`lvfi'provislons�f Section 3700 of the Labor'
Code/ 64thu�jti� comply it {h"ose vl I his.
trate:{ l Appllcanf �--'►
Warning: 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 LatiorCode, 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 rt
i 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 pe'rmit.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 State laws relating to the building
construction, and hereby authorize rep resegntatives of this City W enter upon
the/above-mentioned pr or nspec I n pu poses.
h • +/°� �'
Ignature (Owner/Age �` Date
PER M'T"
BUILDING PERMIT
,
_40
DATE VALUATION 51166,70.40 LOT -�57'+ � TRACT -_;r
JOB SITE qtr
ADDRESS '.�� tTilii�'i~iBd9ft, �9aiY9j1: 1' y-:
APN
4s4Pa3-i�{€
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OWNER. r -
CONTRACTOR/DESIGNER/ENGINEER
r `3 h.t'! ta3 ti`i''!'rrtii3jl'?I 1' �'I"1d„49411d+(t`'i"!K'�'
f.G ♦ i. :.l1\ 1. +�tA t..f C.Y t:..t.t1,r VI.r: N'I l9 tg.J l'J i_/. ll'.f,)
's �f1Pl 4,404-1Vlr:.j r.t'"•/IA.�Y"R7r'!'tl'1"3'i�117''
.t,...1 { 4•-rl t r{tA„ Y\ ��/.
tuft ;lW, ,tii'i ,i l2t i d '1'i?.11`200 ,
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.1,"A J HYR,: j'E1R1: INO CA 924tvk .
Seim 8EMN,Ala.D:I`P Q CA. 'i�2:408
USE OF PERMIT
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t~i,�9.2ri�,in.�Lllif•�11�"!� �� 1_lt! �1;' '
'41) COST firSr.�ri.i�.i� fno+�e'`^
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a,r:►N a:a tti tc;,'VION .FEB tl}t •4lf)0 �I 6 k-tit)t) ?h�zy.t�!
b'Ie{iJ�bli.;t�},f E�,f;; i..Jt �t�il�dris-3lfr $►��_S3.
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PLIJAM.+livt'i ;s7' loll -006-09.4.9)o �l�'�t►13
<,tRO'NCa:h(?,Ctaw1lt}:!� 1�iuJ.�!: Ii+X}I Iifl� as L68
Frf2�i 1€,fa, Ii_rr It 100 Clan 3
lt�3t�..ASIii'1J6,iZ1t1P.Nut 'i)lii�t
AR3,' IN
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RECEIPTe
DATE
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
— o —
Exhaust Fans
O.K. to Wrap
2 —
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 o5c,'
Zt
Final
Final
POOLS - SPAS
BLOCKWALL
APPROW LS
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
Pool Cover
Sewer Connection
16 —
Encapsulation
Gas Piping
Gas Test
/ / 9
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.
" 47-950 Dune Palms, Road
Notice: t ; La Quinti, CA 92253
-Document Cannot Be Duplicated760-771-8515
CERTIFICATE OF COMPLIANCE
- ! .. .. r• r • Irl,- * v d
Date 7/22/98 t ` "i t APN # 604-373` 005
No.. ,. 17378 'Jurisdiction La Quints
Owner NameCentury Crowell Communities 3� • " r Permit# .w '
' No. 797125 Street Victoria Drive R `Log # Y !
City La Quinta: Zip ,x92253 Study Area • .
Tract #' , ; Lot # $quare Footage 2,010•
Type of Development ' Single Family Residence ' r r No. of Units', 1'
s,.
At the present time, the Desert Sands Unifieds School'District does-, not' collect fees on garages/carports, covered
.. patios/walkways, residential additions under 500 square feet, detached accessory 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,
y
reason*,,, .. -
' • ~ ;` EXEMPTION NOT- APPLICABLE ,
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
"1.93 '. X' 2,010. • or $ 3,879.30 ' . ,;. Y ,
the property listed above and}ths�at building]
permits and/or Certificates of Occupancy for this square.footag& in this proposed project may now tbe issued` �y a
Paid B CC/Foothill Independent Bank/Ed Knight, ` I li
v3•
y,' P g CZ-
Fees� f � .. �
Telephone009-3.J 004:1
a Name on the check `,"t
By Dr. Doris Wilson
,Superintendent
Fee collected /exempted by ,Juanita Greeny , Payment Received $3,879.30 ,
;■ Check'No. 604539
5 , ; '.
Signature
NOTICE: Pursuant of Ass )y Bill 3081 (CHAP 549, STATS. 19,96) 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 run fro the date onwhich 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 District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check applicationform to district copy for all waivers. ;.
-Embossed Original- 'Building Dept./Applicant , Copy -Applicant/Receipt Copy =Accounting
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