9606-096 (SFD)LICENSED CONTRACTOR_ DECLARATION
I hereby affirm under,penalty of perjury -that I arri licensed under provision%pf w
Chapter 9 (commencing with- Section •7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and
_ effe_ .
License # t- Lic. Class ,/'�,. Exp. Date
IF
Date�$i nature of ConthrJactoa
r = ^ "s-�� "- 1Aj��4-•
OWNER-BUP n'FR DECLARATION..4•-``�
I hereby affirm under penalty of. perjury that I am exempt from the Contractor's
License Law for the following reason: .. .
( ) 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,-1am exclusively, contracting with •licensed
contractors to construct the project (Seca 7044, Business & Professionals
Code).
O I am` exempt under. Section B&P.C. for this reason
Date ' •=f --Signature of Owner `
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 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 tPolicy No. , I 5
t s J I t •:fa 3, t6 i tt;etp;iti k
(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°agreerthat if I, should -become-'"
subject t?)t a workers' compensation provision s,,of Section ;3700of,the La or
C0 de shall f rthwith comply with those provisions. -•' --" �'
Date_._ Applicant^ "` '
Warning: F�lure to secure Worke s' Compensatinco er ge.is unlawful and
shall subject an employer to criminal Penalties ancivil 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. • s
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 cessatiori of work for 180 days will subject permit to cancellation:
I certify that lhave 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-mentio6ed property for..mspection purposes''01-
Signature (Owner/Agent) Date ! ) f
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"BUILDING PERMIT , PERMT# °°NTR°`#
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ADDRESS
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OWNER - {�
CONTRACTOR/DESIGNER/ENGINEER
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RECEIPT. "'DATE
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 09
F.A.U.
Framing
Compressor
Insulation 0
Vents
Fireplace P.L. tGrills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL AP ROVALS
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
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out ff I
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) [ ( 4 r I
COMMENTS:
,
y
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 # 604-343-028
No. 14621 Jurisdiction La Quinta
Owner Naive Century Crowell Communities Permit #
"j No. 79245 Street Violet Ct. Log #
City La Quinta zip' 92253 Study Area 230
Tract# 25363-1 Lot # 47 Square Footage 1461
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, detached accessory structures or
replacement mobilehomes. It has been determined the above-named owner_ is exempt from paying
.R school fees at this time due to the following reason: '
EXEMPTION NOT APPLICABLE
r -
i This certifies that school facility fees imposed pursuant to Government Code 53080
to in the amount of 1.$4 x 1,461 or $2,688.24
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 350-7464 '
Name on the check, r�
+ By - Dolores A. Ballesteros 4i
r Superintendent
Fee collected /exempted by Pauline Pearson 'Payment Received $2,688.24
Check No. 28118
Signature V` ,fL 20'ALA A .tel/ 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