9606-083 (SFD)-777
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penaltyof perjury that I arri licensed under 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 # Lic: Class ! Exp.,Date
^� t
Dat -� / Signature of Contractor-
=OWNER=BUILDER DECLARATION r' .
.
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):,
( } 1, as owner of ,the proper ty,• 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 •'�
WORKER'S COMPENSATION DECLARATION
I hereby. affirm under penalty of perjury, onetpf the following, declarations:
O Lhave'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 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:
CarrierPolicy No.
(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 -06 )this permit is' issued,
I shall not employ any person in any manner so as to%fiecome subject to'the
workers' compensation `laws of California,,and agr a that if (.should become
subject torthelworkers' compensation pro. -vision's of Section 3700,of'the Labor
Code,l= atl,forthwith comply withthose provisions..
Warning: Failure to secure oW rkers' Compensation cove g is unlawful and
shall subject an employer tO:criminal penalties and civil fines up" -to $100,000;,in
addition to the cost of compensation, dam ges 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 a d tate that the above information is
correct. I agree to comply with all City,.and State laws relating�o•the building
Construction, and hereby authorize representatives of this"C-ity to "enter upon
the above-mentioned property for ins tipurp�s�
Signature (Owner/Age Da
Y r
' :BUILDING PERMIT..
PERMIT# CONTROL#
3537,
r
-9,606-083
DATE VALUATION LOT
'
TRACT
JOB SITE
APN
ADDRESS 79-240 VK i T COURT
OWNER ✓
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CONTRACTOR ENGINEER
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USE OF PERMIT
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.RECEIPT,
DATE" r+... L� i
BY
DATE FINALED
INSPECTOR ..
INSPECTION RECORD
OPERATION
DATE
I 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
BLOCKWALL P ROYALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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)
COMMENTS:
Desert Sands Unified School District S
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=01
No. 14607 Jurisdiction La Quinta
Owner Name Century Crowell Communities Permit #
No. 7924.0 Street Violet Ct Log # �
City La Quinta - Zip 92253 Study Area 230
Tract # 25363-1. Lot # 34 Square Footage 1445
Type of Development Single Family Residence No. of Units
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, 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: y
4 EXEMPTION NOT APPLICABLE
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 check1 si -
By Dolores A. Ballesteros
Superintendent.('
Fee collected /exempted by Pauline Pearson Payment Received $2,658.80
Check No. 28118
Signature �P1t_ t i Q � 2, ,A AOA"'—
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