SFD (0301-114)61L 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
X3'7!40?4 B> IC,
Date Signature of Contractor
OWNER -BUILDER DECLARATION
7/31/03
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, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). L"
( ) 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 ST,ATg; rittrNI) Policy No. 046-73394003
(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 forthwith comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful 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 authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
OCL-1��
DATE IW,0 i VALUATION $240,11,7'1{8 LOT 59 , TRACT '219283
JOB SITE
ADDRESS 79-4154&TISKODT DWIVE WLP.%�'�
APN
649.210.06'
OWNER
CONTRACTOR / DESIGNER / EN (NEER
'(°D DTt3''L71~ VL:i001s3vIF. a3'
SPARKS COMSIRUC'11 9
FO BOX 1716
79.295 i;A:4d'(;HO LA C?UMADR
LAQUNTA _ - , CA 92253
L& QWNA CA 12253
(760)771.1941 CM -4 2996
USE OF PERMIT
SINCTUF .M 11L Y DiA ELT -INN
SFD - LO; 59, PLAN L2FL PLPlrfMIT 17ON..7NKJ,i' INCLUDE 86OC C
WALLS, P004 SPA 011 DRIVTiWA.Y A.1'I°Rt3At;R 74% REDUCTION TO PLAN
CHECK }+LrZ DUE TO MULTIPLE ISSUANCE O'F SAME PLAN TYPE
C'idGMM CONSTRUCTION 2,974.00 WIC
1?OIZG'}�fx'A'PIt� 23S.Ofl S>�
i>
0-A1:0.,0.I9WA+1 PORT 410M Sig
0:091 (3r' CONS'g`g�`I�CZ`xON
240,117.10
�y9 yy y
1 I'CJA'B 0.1 VX% i MAWt 3,
CION:STRUCTION'FEE 101-000-418•000 $1;133.00
'PLAN C HECK ,i+'1;EE 101-000-439-318 $232.24
MECHANICAL lrh?, !. 101-000.421-000 $130.50
ELF; C't RTCA"L 2+EL• 10.1-000-420.000 $169.24
PLUI DTiaOFFE 101-000-419.000 1111,5,`
S TRON (MOTION FE9 - RESIT) 101-000-241-000 $24.01
ORA17ING .@SEE 101-000-423-000 513.00
OV LPJ., )PER IM PACT Def E $2,4P5.60
ART INPUBLIC PLACES - M!K 270.000.445-000 $100.29
STUB-TOTALc:''Ca.MTR%TG°l'IOA7ANy}J�7pF'ry'I.A7A�3�jCyRECyT¢%.
$d,3�83.033
=y.p/
J.G iA7U ,i..R'18i�.A A"'1.43/'L .Wig
IG LJ,0
rOT1.4 , MMYr le 7ms D NOW
$4,385,03
RECEIPT
DATE
BY
DAT INALED
INSPECTO
INSPECTION RECORD
R OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings - d
Slab Grade 3
Ducts
Return Air
y
Steel
ombustion Air
Roof Deck _ / -
Exhaust Fans
O.K. to Wrap - f/
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
ell
Exterior Lath
Drywall - Int. Lath
Final
— y
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam _
Approval to Cover
,J
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines / 2C,
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District �q�cS��t1T1fU�„�o
47950 Dune Palms Road
Q BERMUDA DUNES r
Date 12/16/03 La Quinta, CA 92253 CA RANCHO MIRAGE d
�. INDIAN WELLS
No. 25280 (760) 771-8515 PALM DESERT
LA QUINTA �y
QINDIO
Owner
TD Desert Development
APN #
649-210-067
Address
PO Box 1716
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0312-111
Tract #
29283
Study Area
Type
New Residential Addition
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1 59
79454 Mission Drive West 128
Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 128 S.F. or $273.92 have been paid for 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 CC/Palm Desert Nat'l Bank - Judy Halpain Check No. 087879
Name on the check Telephone 760/771.1941
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvrey Payment Recd
$273.92 Over/Under
Signature `
NOTICE: Pursuant to Government Code Section 66020(d)(1); 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 the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Certificate of Occupancy
T4hf 4 4 a"
Building & Safety Department
This -Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of . issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
Use classification: S.F.D.
BUILDING ADDRESS: 79-454 MISSION DR. WEST
Building Permit No.: 0301-114
Occupancy Group: R-3 Type of Construction: V -N
Owner of Building: TD DESERT DEVELOP MENT Address: PO BOX 1716
A CONSPICUOUS PLACE
Land Use Zone: R -L
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 07/15/04