9701-003 (SFD)• 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 --'"E vD
67-107 13 - �"� 1� �i
/Date 9^s 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).
( ) I, 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.
(,r) I have and will maintain workers' compensation insurance, as required by
S48tion 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:
Cartier Policy No.
SN11,01.1 1; )N11)
(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 Calif ornia,.and agree t�t if ecould become
sub"ject to the workers' compensation provisions'of S t tio3700 of the Labor
bode, I sh Info hwith comply with•thos p ovisionsz,�,,
Date: 4Appliearif �✓ (((
Warni g: ailure 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 r,
whose request and for whose benefit work is performed under or pursuant toy
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 Stelaws relating to the building
construction, and hereby authorize representatives of this City to enter upon,
t he°above-mentioned property.for iospectiooq.p?rp- oses.
re (Owner/Agent)-- -- """` t." - Date
r J
BUILDING PERMIT PERMIT# CONTROL#
9701-003 4788
DATE 3
/7197 VALUATION $ 67,665.5111 'LOT TRACT
JOB SITE
ADDRESS 79.425 KRIAi�tV4'OOD
APN '769-760-015
OWNER
CONTRACTOR DESIGNER ENGINEER
LA QUIN'A. ORCHARM\INILS
SPARKS LivMUCTIL014
P.O. € OX 17'16
79295;R l.NCR0 LA l?Uli+1'i.t , DR.
1,f1t U11+11'�► CA 92253
LA.QUNTA CA. 92253
(60)771-1941 i C13LO 2996
USE OF PERMIT
S1:0416it'M!'t' OOKS NOT INCLUDE tA.CS'"' WALLS OR POOL.
SF
0ARAGI."iCARPcJ T 808.00 SIF
cfj.ln,t_ m CXINSIM40t,7Y(7.x 4,478,00 S1+`
RJL 1f NT OV 4l.it'v,3rA'�.k1i/1.. J.1.ON
ti1,At4 (111700 v rH 1{11 (�f111d 'i'�_ NK �i tftt.?;b3
{.. 1.0 1 -GOP, A 119^'000 9�y.ir l,.J•l
rt�tf:�o;iAt3'C4'xai. irl.ls i i� i-Oixi-rill-iiC1R ► � 1,'3i1.5u
E'Lf f "FkICAL FEE 1;11-{ XII -420, ?t) $279 31,
t�1,ttq.tt;1f�1(i i�ftfr Y(1� �)tDC)-41}-!)f?(1 �"•f�ti iNl
A. .440i.'.G: TION11:'0; -1tV 11.1 101.OM-2•11.-000 $36,77
�''••i:'k1xIi1.31I�d4: l�1ii. ltii-CJi1��+1�:3•C?fN:) 3i241.!'til
1.1yi:l2AS'I13 fr"1'1llttti.fW Z25w0(0 11-347 *fe,!tttr►,!tGf
AYT tN3' 1'1T Ir, P),At',ti,S .'ItF Sif; 701.44-2n•f10}f) $6N:4>.1.6
ti
StA.'1rC1TAL t_'t1NS'1'It1=r,N ANY)PLAN LAN CNIECK
! "i11 i 21
LESS :E}l; I-4'AW-19ES
��
-$1,000.00
..
'1't.!'!'Al,,C'ERMIT �'d;'.&:S #11J.C'� i OW
:. -
S9,: 01121
MAR 1
RECEIPT, tr i ffA'r E
{
BVe
DATE F NAL
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
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final r
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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
COMMENTS:
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)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 3/7/97
No. 15312
Owner Name La Quinta Orchard Partners
No. 79425
City La Quinta
Tract #
Street Briarwood
Lot #
Type of Development . Single Family Residence
Comments
APN # 769-760-015-1
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 117
Square Footage 4478
No. of Units 1
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.84 X 4,478 or $ 8,239.52 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 La Quinta Orchard Partners Telephone 771-1716
Name on the check
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $8,239.52
Signature P4 A A Q 11AA 0 QAAAA_01/1A
�v
Check No. 4005
10TICE: Pursuant of Assembly 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
bove will begin to run from the 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
ollect them on the Dislrict('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