9606-095 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
1 --Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect?
7) c') License # Lic. Class 4t A' Exp. Date
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Z r- Date
/;' k"' Signature of Contractor
J7/7
V °� OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL
~ U) License Law for the following reason:
Z_ ( ) I, 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 project (Sec. 7044, Business & Professionals
Code).
ce) () I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
LO - O () 1 have and will maintain a certificate of consent to self insure for workers'
X W !�= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O C Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
NI- z Carrier Policy No.
c0 5 /d8fdt•ttl IA tali, r(li�.l4it7.`it)I
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J(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 to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor..—
Code, I shall foofiwith comply with those provisions. y '`
Date., Applicant t"
r �r' , .; ,....��—^•""'" "_ ,..-"-
Warning: Failure to secure Workers' Compensation coverage -is unlawful and
shall subject an employer to criminal penalties and ivil 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 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 representatives of this City to .enter upon
the above-mentioned property for inspection purposes
Signature (Owner/Agent) W, �_ Date_ _
BUILDINGPERMIT PERMIT# CONTROL#
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, 3548
DATE V LUATION LOT. TRACT _
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JOBS E
APN
ADDRESS /�-•,;1 10 IYlf a t~3(�1(.
E0"4,xftll
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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USE OF PERMIT
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<fAf2E1<il+l+,^AIRPf'RI, 721.00 Cf
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f1 k,t 't'Ftlt_" Vit„ f��ali Ittl dl£ 2tl�f1i3� $11.1t 65
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c.t!.:otlla.C1't[t.xPdi`ei: :i1aSi}F fCI: fi1f�1)>i<.j! f)M
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RECEIPT
DATE'-•_-� -_
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 11
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap Z0,
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 A P 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 4z J
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 APkOVALS
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 r
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE. OF COMPLIANCE
Date 6/19/96 APN # 604-343-027
No. 14620 Jurisdiction LF- Quints
r a
Owner Name Century Crowell Communities Permit #
No. 79235 Street Violet Ct. Log #
City La Quinta zip 92253 Study Area 230 .
Tract #, 25363-4 Lot # 46 Square Footage 1678
Type of Development Single Family Residence
No. of Units 1
Comments
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, detEched 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: 41
a
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of ° ;1.84 x 1,678 or $ 3,087.52
' the property listed above and that building permits And/or Certificates o= Occupancy for
-_this square footage in this proposed project may now be issued.
Fees Paid By Foothill Independent Bank -Topaz Telephone 33604464 7. "•
Name on the check
By Dolores A. Ballesteros a=
'Y
' Superintendent ` r ` •.
Fee collected /exempted by Pauline Pearson Payment Received = $3"08752` = . -
r
Check No. 25118 r"
Signature _ (� A-1 Qp M u ora .^ �✓✓� +
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'
MAY 14 '97 04:30PM
M
P,. 2/2
I -c v
"HOMES
EN-rURY
Century-Civ,weli Commurildes
SIGNATURE AUTHORIZATION
I hereby authorize Dennis CwirLghasm amd' Cenwry Hornes to signon' my behalf
&T pemdt purposes regarL, ng my residence louted at -0 Le' 7- 7—.
4/41;� 7w Z
This authorization is valid through 917
AddIc S
-13
Phont, No.
A
` MAY :L4 • ti tea : 3300['1
P
,
: .3i2
cs AND URBAN uF.vc►.Ui> G� r�FARTMENTIO� j v"tpL �~ OF LOAN �
`t. I I rPA 2, I I rW tA 3, l 1 CONY. UNIM
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236697
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G. NOTE: ' 1ltts lorrtt is furnished to give W,() a st�fterttnrit bt a48uar s�dte+n.str c®9fs. Amounts f� Y
se Piteyl:':7! agent are shown• lir:In9 i�tart:cd "lf?,n.s:)" were Maid outside lite :lasing; they ore shown here
Oru`.l,tln, miatlonal p ap6ies acid are not included ;n file total::.
'A��E C)F� RI"tCiWFfi: DEi�iS A. " C' '�Ly its," _--........... j._..,_.._•..._—_,.,..;.. .. �. ....._,...-_.V.�..�.
FJ. N •
,ADDRESS: 'ii. 79--23:. VIOLET. COUR-T, LA QUINTA, CALIFORNIA 92253
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F.' NAME OF sFi-3._FA: ~� '!t�Pi1Z ASStJCI.A'iFS ,
F, NAME OF NDER _ .QUA�LTTY HOME LOANS r
r�.DDt SS: 500 L''AS`l' ESPLANADE DR.IVE SHITE 1fl2,`OnNfiRD, CAI,IEORNIA 93fl30
�•= LOCATIbm 791-235 VIOLET COURT, L"1 QUINTA, CALIFORNIA 92253
�. SC7T>.EWET AGENT: THE ESCROW `LONE ___.' I:; .� .�..__� �..�..._,._�...�_........,�..�..�.._....._...._ ' ..
5Fr_ LEMF.rrjjT F'iAGC; 1425 WEST FOOTHILL BLVD. ,iSCIiTE 130 OF°LAND, C.A 917E35
•
I.. SETTt.E�+l���p' DATE,',r J � � f'). % 37 --_.�___�.�.._._ ,_��.__._.. ,•_-._-__..�.u__:._.__..._.__ '
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