SFD (9805-143)_ „r:
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 r -E p Date
�` `�`�i3il"S3ie
ate °?f ''` Signature of Contractor
OWNER -BUILDER D
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:
(.,) 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 Policy 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 which this permit is issued,
I shall: not employ any person in any manner so as to become subject to the
worker's' compensation laws of California, and agree that if I shouldbecome
subject todthe workers' compen sation.provisions' S- tion 37001of thell abor
Code, I shall forthwith comply with't6se provisions. � 1
ii,6ate"-fl t ' Applicant_. eP f
Warning: Failure to secure Workers' Compensation coverage is unlawfu and
shall subject an employer to criminal penalties and civil 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.�uthorize representatives of this City to enter upon
t4above-mentioned property,�for'i 1pectl n purposes.
/Signature (Owner/Agent)'' Date
BUILDING PERMIT' - PERMIT# °NTR°`#
9905-1.43
DATE ��!`� I °i b. VALUATIONsX7,ZD� LOT} TRACT221
(8
7
JOB SITE
ADDRESS„t;js36��fi169�nt>�.�'.�I!;�L
APN _
9i44-DA�EP>Ij9
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RCS. 3. e i� A; 17 16
79195 i A'1,41040 LA QOINTA ISR..
;!AOt.:ttvTA CA 92L53
LA QUINT.., CA 9225-
(M0177 I 194 t CT -31.0 :2991:
USE OF PERMIT
i5�t"i.�
'r', A. -'
ISR) - 1 i i (h-14, i'i.AN 24 i1 14101!L„5 NJ`e '00T. INC OFO(PYSl.
t7l
Wr1:i.s;;i t }I•t•Z' K Ff., PLANC tIf r Et} I s;JC } L� 751/4 FO Tbliif.`1'fY4
`d m 9
tRf
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('1?'.A'tt it343.tN1 �,t.
N5 a a7�6 �i 6`,
GARAMUCAftKOWf tea :�cr
ri.s 'Ali'SR'�ll .is�i Ci..i 3.111. �.. * C.'f.YiY Ai.E�ra.rIONi
327�afi.�r,1G'��
CONSTF, UC T10N FEE i0l.-VW418,000 $1,437
PL.kN C lit;.G1o.:Mks ; i i {1 1,).,, 3g_ t tl ; 5289.4 3'
fVli3r�NtiL"•A.f..ti'�t.'s• 1fl1•t�t�-F4'�:4••litl[3 `�" v.Ttf;.d3t)
ELEZ1.`itfC M, 4`1;1.1 $218.39
LUNIB Nt; ,1TE I01' -006419-(X)0 $191.25
STROM-1,N40`1'ZONFIR RESIN
{1(0.4-/M�q(O-29941-000
:
GRA.17T140 I'M
1N.FR A -I i U U' Fi:?? M-000-443-3421 �3 :i"Jt)t►,t
ART IN PUBLIC PLACV-4 MIR] r, 7064M-2,55-wo $56& 0_1
$8,875 M
LESS PIM-P.A.ID VETS
nO,Uti
TMAS:.I'irA7fMI"i FEV401,?CNOW
RECEIPT
DATE;�/%
:By
DATE FINALED
INSPECTOR
f
�l .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�/
Underground Ducts
Forms & Footings
U
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
_���
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
— O
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 APPROVALS
POOLS - SPAS
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
Waste Lines �� _
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
�� . / i/./
—`Z 6""
Encapsulation
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
t
Final
Utility Notice (Perm)
COMMENTS:
C
sli
Desert Sands Unified'School District -
47-950 Dune Palms Road -:.r•.:. 'Y
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 8/5/98
No. 17458
Owner NameT.D. Desert Development
Jurisdiction
No. 71W. 045 Street Mission Drive West
City La Quints zip 92253
Tract #
APN # 646-020-040
La Quinta
Permit #
Log #
Study Area
Square Footage 272
Type of Development Residential Addition No. of Units 1
Comments
House currently under construction.
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:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to in the amount of
1.93 X 272 or $ 524.96 the property listed above an- h -'at building,,
permits and/or Certificates of Occupancy for this square footage in this proposed p*ojct may: now be issue`+
Fees Paid By CC/ /Spark Construction -Judy I elepliune; 771-1941
Name on the check A- , e
By Dr. Doris Wilson r ^'�„�.� r
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Received $524.96
Check No. 73535
NOTICE: Pursuant at Assembfy Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from Me date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
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
Otl(_ 4!o _ o40