9606-094 (SFD)LICENSED CONTRACTOR DECLARATION /'-
I hereby affirm under penalty of perjury that I am`licensed lander 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 # Lia Class Exp.,
Date
H l
Ilk i !
Date•4° ./ Signature of Contractor
' OWNER -BUILDER -DECLARATION t ,
�. • _ .
I hereby. affirm under penalty of perjury that I am exempt from the Contractor's
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
sale (Sec. 7044, Business & Professionals Code):.,,-
( ) . I. as owner of the property, am exclusively contracting with licensed
contractors to -construct the pr-oject (Sec. 7044, Business &;Professionals
Code). ; .
O I am exemptrunderrSectior B&P.C. for this reason
Date r $ignature of Owner
y ..til.•..
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 forrby 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 r� " ' • Policy No.
LL.f�t°!?J tfV ,irk. atW4-sty�U9
(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 io become subject'to the
workers' compensation laws of California,,and agree that if I showuld beco rf ie
subject to the workers' compensation,provislons of Section 37007of the Labor
Code :I shall forthwith comply with those provisions:
Date/ `f -o Applicant
Warning: Failure to secure Wof e -r nsed n 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 applicationtand state that the above information is.
correct. l,agree to comply with aI[City,fand State laws relating -to the building
construction, and hereby authorize. representatives of this-6ty'to enter upon
the above-mentioned property for, inspection purposes..
Signature (Owner/Agent..-'' Dat
Intl I BUILDING PERMIT PERMIT# CONTROL#
9641")94. .31547
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OWNER',
CONTRACTOR/DESIGNER/ENGINEER
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RECEIPT
DATE 1
— -
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
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
POOLS - SPAS
BLOCKWALL APP OVALS
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
COMMENTS:
Finalh1fi7 -1-t Ig
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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)
r
Desert Sands Unified School District
Notice:• 82-879 Highway,111 e
Indio, CA 92201
Document Cannot Be Duplicated . 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/19/96APN # 604-343-026
No.' . 14619 r Jurisdiction' La Quinta
Owner Name Century Crowell Communities _ Permit # -
No. 79225 Street Violet Ct. Log #
City La Quinta zip 92253 Study: Area 230
Tract # 25363-1 Lot # 45 Square Footage 144`_
Type of Development Single Family Residence No.'of Units' 1
Comments .
- r At the present time, the Desert Sands Unified School District does not collect fe•,-s 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 reason:
EXEMPTION NOT APPLICABLE
t This certifies that school facility fees imposed, pursuant to Government Code 53080
in the amount of • 1.84 x 1,445 or, $ 2,658.80
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 check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by- ' Pauline Pearson Payment Received ;62,658.80
r Check No. 28118
Signature
k�A1AA0,-YV_
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,