9606-093 (SFD)LICENSED CONTRA;" - ti ,� _
I hereby affirm under penalty of perjury that l ani licensed under provisions of BUILDING
Ch4pter 9 (commencing with Section 7000) of Divislon'3 of the Business and. DATE ALUATION LOT
Professionals. Code, and my License is in full force and effect L S"W,474,•. 0
License# Lic. Class ', ` Exp. Date ' � ` ''�- • "
JOB SITE r
ADDRESS 70-216e► IOL;"aT COV91.
r
-'PERMT-H ` CONTROL.
9606-093 TRACT
44' f . d53 3-1 1'J_1
APN
Date ��° .Signature of Contractor �!Z^ --"'-7-•'"�•� "~� OWNER _ CONTRACTOR/DESIGNER/ENGINEER
OWNER -BUILD R�DECLARATION CENVIV17X C(,QVVE.,I.L-CON'�i 1�s�')L'j`E .`' 4..1 T1t'1 Jit ' CF,t�`�rELL CUh'��t�1:3P:ifi.t S
I hereby affirm under penalty of perjury that I am exempt from the. Contractor's 1515 SCS. " 1:)' ` RFL'}``1`, �'1 1 . ��.�s?�i 1Pa5 so, is" �".1`jtZa r,, w 1'.i';, it`wo
License Law for the following reason: ; . SARI 8�+�[�AjA zbirt, CA 92,109 SAN 818 . IAR'OINO CA 52408
( )
'I, as owner of the, property, or my employees with wages as their sole_ �� :. q
compensation, will do the work, and the structure is not intended dr -offered for �+RLwdi)i• {0l3R1 �iQOi _. E �1L#€ alfi
sale (Sec 7044 Business & Professionals Code). i USE OF PERMIT
(.) 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''%.` 4
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
(,) I have and will maintain workers' compensation insurance; as required by
Section 3700'of the Labor Code, for the performance of the work forwhich•this '
).permit is issued. My workers' compensation insurance carrier &-policy no.'are:
WRi�ir IJ1,%;i. 11atll:.
`Cf�;i1G� d' C'UI�iS'!'kIs(� f'f[J:tJ
Lamer ;. } Policy No.. •
O(5,' ; • - , • 21k1 t'ks6�r71 , . ,
F,.�f�fi��lMl.La" �1a D COSTOF CON-51�{�}lam".iJONI
%a.1 ��'IiJN$f9�d�`
'
(This section need not be completed if, the permit valuation is for $100.00 or less).
I'r.`LN G`fi Ch. (y1 1"
F1`-�39-31 $�i3od6
O I certify that in the performance of the work for which this permit is issued,
1 shall not employ any person in any manner so as to become subject to the
CtJ1d4aIlZUMICiiJ FE
101-0004118-000
workers' compensation laws of -California -,,an gree that if I should become
RO; i✓c1AAI1 "Al: '(
101.-O(ifl-��I.-GOfl
subject tofhe workers' compensation provisions of Section 3700,of the'Laborr�C,
"
i"} f..'10.1
'
-9M.420 -WO
Code,l? al f•ithwith Comply wlth'tho,se•provisions -•'
/fi ''��—"^:ate=M".
t�} tF?31C�F"%t t'
Eflj iiti^.19-Q1YJ $l b}3.f'd?
Datef •Applicant'
'
kla,11010 F ftEti�r3
101 -000 -241 -ZOO
Warning: Failure to secure Workers' Compensation -coverage, is'unlawful and
1{i,j3i?Q-42-i)
shall subject an employer to criminal penalties and civil fines up.to $100,000, inii�111Jltdi.i•}J:
addition to the cost of compensation, damages as provided for in Section 3706
125.ON44.3-347.
of the Labor Code, interest,and attorney's fees.
IMPORTANT. Application is hereby made to the Director of Building.and Safety
) .'
fora 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
>,�
i SA �'f '�91,�6NS RUCTTION r»d'P}'AN C 1'
any permit issued as a result of this applicaton agrees to, &shall, indemnify
hold harmless the City of L`a.Quinta, its officers, agents and employees.
•.
' TRESS PRE. -PAID TES
2. Any permit issued as a result of this application becomes null and void if
O
L:r"—�J . -
work is not commenced within 180 days from date of • issuance. of such
. ; , . ' 1!At1'%A11 1 $,:;,5 :liDl1ly NQC3W
permit, or cessation of work for 180 days will subject permit'to cancellation. •
t ,
J'U•N: r � :196,'
.
I cerfify,that I have read this applicationand state that the above information is
correct. I agree to comply with a60ty, and. State laws rela Ing o the building.
nstr" cion and'hereb authorize re resentatives of -t ii -'it * toI enter u on
?
co u I ,
the above-mentioned property'for inspection purposes.�7 - '
r / r RECEIPT DATE v BY DATE FINALED INSPECTOR
Signature (Owner/Agent)
fes,
Rte`• - `,�'.i"'` - . l= r
$3,730.23
43,730.23
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 07
Exhaust Fans
O.K to Wrap 10
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
POOL'S = SPAS
BLOCKWALL AP ROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping 1756
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL AP ROYALS
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 is
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/19/96 ; " APN # , 604-343-025
14618
No, Jurisdiction, La Quinta
Owner Name Century Crowell Communities Permit #
No. 79215 f Street Violet Ct. Log #
City La"Quinta Zip 92253 Study Area 230.
r
Tract .# 25363-1 Lot# 44 Square Footage 1663
Type of Development Single Family Residence 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 a-.cessory 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:. M
EXEMPTION NOT APPLICABLE r
This certifies that school facility fees imposed pursuant to. Government Code 53080
in the amount of 1.84- X 1,663 or $3,059.92
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 Foothill Independent Bank -Topaz Telephone- 360-7464
Name on the checka
By Dolores A. Ballesteros%~ y ,
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $3,059.92 .
•
Check No. 28118
Signature as P, AA nA OVV�-
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