0108-182 (BLCK)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am 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
i+
go
Date X Signature of Contractor;. _ ?��
OWNER -BUILDER DECLARATION.''
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() 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 one of the following declarations: r
( ) 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.
h' 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 Policy No.
INDI �t}1'1`Y ffillul, � KI011812•00
(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 Califor i
t INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
I
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
,
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
{
Compressor
Insulation
I
Vents
Fireplace P.L.
i
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
I
Exterior Lath
Drywall - Int. Lath
i
I
Final
Final �
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Bond Beam
Main Drain
Approval to Cover
Equipment Location
1
Underground Electric
Underground Plbg. Test
Final
�j-3�_Q
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
I
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
,
Pool Cover
Sewer Connection
I
Encapsulation
Gas Piping
Gas Test
Appliances
{
Final
Final 1
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 1
Low Voltage Wiring
Fixtures I
Main Service I
Sub Panels
Exterior Receptacles
G.F.I. ;
Smoke Detectors {
Temp. Use of Power
i
Final
Utility Notice (Perm) 1
COMMENTS:
Coachella Valley Un d School District
P.O. Box 847, ThMal, CA 92274
(760) 399-5137, Ext. 235
This Any Fnr District I Ise Only
DEVELOPER FEES PAID
AREA:
AMOUNT: RCPT p:
CK p: CASH:
INITIALS: .DATE: -
CERTIFICATE OF COMPLIANCE
(California Education Code 1.7620)
Project Name: Date: July 18, 2000
Owner's Name: Uan "ammond Phone No. ( 760) 771-2215
Project Address: -325 Vista Montana Drive a ui nta, CA
Project Description: One Dwelling Unit
APN: 772-260-004 Tract #: 14104 Lot #'s: 4
Type of Development: Residential X Commercial Industrial
Total Square Feet of Building Area: 42899Ssq. ft.
Certification of Applicant/Owners: The person signing ce
under penalty of perjury and further represents that he/she is
Dated: July 18, 2000 Sianat
that the abovf� information is correct and makes this statement
sized to sign J behalf of the owner/developer.
A
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project
17620 65995 Approval
.Number of Sq.Ft.4,899
Amount per Sq.Ft. $ 3.26
Amount Collected $ 15.,9970.74
Building Permit Application Completed: Yes/No
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
Note:
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Administrator in Charge
E1 Facilities An 1Sia
Certificate issue: tiy. Elsa ESfauC�a, a _yS S gn
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES .
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the.Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment. of the fees or performance of
any other requirements as described in section 66020 of the Government. code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificte of Occupancy. As in the latter, the 90 days starts on the date hereof. This '
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School
District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this.Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.'
Rev. 09/27/99 r