9606-084 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury ury that I am licensed under provisions,'of
Chapter 9 (com,mencing with Section 7000) of Divisi6n.3,of the, Business and
Professionals Code, and my Lice
nse is iri full force and effect.
License # Lic. Cliss ,E�p. Date
tpiti ?s
Datel/_�_-A z X2e Signature of Contract
OWNER -BUILDER DECLAA ON
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
l,'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).,
1, as owner of the property, am exclusivel)�;Contracting,:,�itk lic'e'nsed
contractors to construct the project (Sec. 7044,.Pusiness. &-,Professionals
Code).
O I am exempt Section"
B&P.Q.-for this reason!
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I. hereby, affirm,under pe6Al . cif Perjury one of the following.. declarations:
)'I have and will maintain'a.dertificate of consent to self -insure for workers'
compensation, - as provided 46r,6y Section 3700' of the Labor 'Code, for. the
performance of the work for which.
this permit is7is , sued.t'.
.( ) I have and will' maintain workers' compensation insurance, as.reqyired by
Section 3700 of the Labor Code, for the performance'of,the work for which this
m
permit is issued.'My workers' compeation'insdrance carrier & policy, no.. are:,.
Carrier Policy No.
Z04' 150596 1
'(This section need not be Completed if the permit valuation is for sloo.ob 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 s(:ra; toj6come subject to the
workers' compensation laws of'California,,iand agree that Jf I'should become"
Subject to t , workers; compensation, l5rovisions, of 370-6;, of, th6-66�r
I . . ., .
Code, 1vslhall forthwith comply with those provisions
Date,"%/-*'4/-�&_ Appiicant
Warning: Fad, ire ttilsecure .,WorkL-rs;C-oriiperisatlorl,bdverlg�-e—is unlawfuk6hd
shall subject an employer,to criminal penalties-@affdtivil fines Up to $100,000, in
addition to the cost of compensation, damag6s as provided for in Section 3706
of the Labor Code, interest and attorney's, fees.
IMPORTANT Application ishereby made to the Director of Building and Safetyfor a permit subject to 't . he conditions and riitrictions. 'set forth .9n• his.
application.
1. Each person upon whose behalf this application Is made - e & 6ach'pe'rso'h, at
whose request and for whose benefit work is performed 'under or pursuant to
any permit issued as i 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'suich
permit, or cessation of work for 180 days will subject permit to candellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply With all City�lii;_State laws relating to the building
construction, and hereby authorize representatives of this City to_enter upon
the above-mentioned propqrt 0 r inspe6fii6n'purp6ses;1;5;0
z
§ignature.,(Ownef/Ageht ate -
PERMIT# CONTROL#
.:,BUILDING PERMIT 3538'.
I . . . . .
.DATE LOT VALU TION .:TRACT 474J0
S A5
2'
JOB SITE
-7
APN
ADDRESS
79-136 VIOLE I COURT
'OWNER
CONTRACTOR/DESIGNER/ENGINEER
f, L COM 4114,041T, TP .1.
C7,MRY %CRONVELL CMINTUINTRE'S
Ob -5 so, :;,f)' STREET, STtA.200
$ANJ3_EKNArkf)1X- C& 92403
SAN WUN.A.101YINO CA 92,408
(904.1381,5 -7
I'm -2
CBL# 120
USE OF PERMIT,
4 - ASSOC.
g, Q alfl,4., N el,
f*4iAX V A Wil VrA 7% ri1, 1 W J (1
AVV
R. F, V I a. P_ C. c 2 s t
00. Pk.Y ANTA NIOR
4.i 7,60 SIS
9&47-430
PRRAUT YKE—SONVIWARY
'KAN (,TMr.K F!7E, 1 -PQ -439-3 R .$Isll 6
txx 46 3 5. W
.0
M-4!9- mw
:7T0 40 MCiTtONFL - TIZE.,40 101-0 W- 2.17-000 19 5,
AfA 0-$20.00
v* Navfw, I'Of-06 X2.=(3 . )
IVREJ,166 225-(Y)0A43.1i142
A
J,CHECIC
L $5 -'�R M
ES I k�PAJDJ;ST�
CAL P r I; E 44 _DVE NIONY
RECEIPT.
DATE
BY
DATE FINALED
JINSPECTOR
0
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
00
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 P OVALS
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL WPPAOVALS
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 '1240-
LIU14 Notice (Perm) `
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/19/96 APN # 604-343-016
•• r
No. 14608 ,. Jurisdiction La Quinta '
Owner Name Century Crowell Communities Permit #
No. 79230 Street Violet Ct. Log #
City La Quinta zip 92253 Study Area 230
Tract # 25363-1 Lot # 35 Square Footage 1663
a
Type of Development Single Family Residence No. of Units 1
Comments w
At the present time, the Desert Sands Unified School District does not collect fees on garages/•.arports,
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 fron paying,
school fees at this time due to the following reason: -
EXEMPTION NOT APPLICABLE
Government Code 53080
This certifies that school facility fees imposed pursuant to d
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 '
r 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
- ,_ t •��' 'tom`
Fee collected /exempted by Pauline Pearson Payment Received $3,059.92
Check No. 28118 ,
t.
Signature �� u,Q�n SL p4.(I111X1- a
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.