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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
674074 13 1j 71:�1199
Date 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.
()o 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.
ST TE �� UIND 046.411 bft� rO00 7335
(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 -ifs 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant tot
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the ,building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT"1u-10Z CONTROlL#/�
DATE VALUATION SI �3S.9:.SU LOT TRACT 28,7, `1
(A
JOB SITE
ADDRESS 78-"% CALL E SR1SA
APN 649-210,003
!
OWNER
CONTRACTOR / DESIGNER / ENGINEER
T.D. DESE1:T D '1T_LOf'i11"i;NI SPARKS
CUt,, i u,(710N
P.O. BOX 1716
70-295 RANCHO LA QUiNTA 1)R,
LE►. QUiNPA CA 92253
LA QU1NTA. CA V2253
C,760i77j-194i C11L81 7�H
USE OF PERMIT
SINGLE FAMILY 11',N.t?l.LiNG
3M- POCN11T W&S 1407 INCLUDES BLOCX WJVLL OR 1100L. WITIAL
C ONyi'EttXTION F'Qk USB AS SAI.Er, t Ft,"fC.`Em.
CUSTONI CON3111Ui,TlOIN `,RX100 ST'
PORCH11IW1710 254.00 SF
GA RA.Ci.WC;Ai<,i'OWF 605.00 8
x+:.4071141,&7 V COST OF i.;Y)NS'sR! CII ION
23S,'..S.150
1"ERNOT FES; SritMINIAR
WNSTRUCTIONFFF. 1Ud-Uf)0 e1113$iit)U $1.liS.v1
PLAN CTT ~CK 'F . ! 10 i-t3{ifi-,A�a.3'(R X912. �i
iEWE AtWCAL FVT: 101-000-4111-000 Sr.fK)
hii.> wC1RliCAL 1;F-9 101-000-420-000 S l.8.3.7f;
P!,LJ 4fJfW!I" E 101 -tom) -419-000 Si115,2S
S'l' ONC 1ViO'!"TON F7: - itPSH) 1411 -0(1(1.241 -OM $21.411
GItAOING i°t.-"s 101-000-123-000 $2001
1?dF12A.`s'iti3�"s'iJKa:"11 £ 215
A
g 803-`1'tY1'A1, COMSMRUCMON ND 1)1,AN C'11
S7,765 30
LESS PI: E -PAID PEES
$().(Xr
J�0
� 1�ga a ,
Nov 1
P r. 61
RECEIPT + q
DATE
BY
DAT FI LE
Ll
INSPECTOR
�41
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- /_ 9 Yj
Underground Ducts
Forms & FootingsDucts
Slab Grade
- Z —
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 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 Pibg. Test
Final
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
c.
Final _
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 11/4/98
No. 17951 Jurisdiction
Owner NameT.D. Desert Development
No. 78-995 Street Calle Brisa
APN # 649-210-803
La Quinta
Permit #
Log #
City La Quinta Zip 92253 Study Area
1
Tract # Lot # 36 Square Footage 2,833
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 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
1.93 X 2,833 or $ 5,467.69 the property listed abo,,el-and that building
-17
permits and/or Certificates of Occupancy for this square footage in this proposed project may now.be issued
Fees Paid By CC/Palm Desert National Bank/Judy Telepifone ',
Name on the check a
By Dr. Doris Wilson F` 'f, - •� y
Superintendent
Fee collected /exempted by Juanita Green Payment Received $5,467.69
Check No. 74198
Signature
NOTICE: Pursuant of As#mbly 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 fr 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
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
Cary W4
City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: 1 Single Family Dwelling for use as ialec Office (plans in Bldg. Dept.)
Rancho La Quinta, Tract 28640, Lot 36
Applicant Contact: Nolan Sparks, Sparks Construction, 771-1941
Applicatio / Circulatio ate:
Date
Community Development Department
Christine Di Iorio, Planning Manager Date
Public Works Department
Steve Speer, Senior Engineer
Building and Safety Department
Mark Harold, Building and Safety Department Manager
Health Department
Fire Department
Date
Date
Schools Fees Paid
Date
Date
Date
0%. (SKS.
City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: 1 Single Family Dwelling for use as Sales Office (plans in Bldg. Dept.)
Rancho La Quinta, Tract 28640, Lot 36
Applicant Contact: Nolan Sparks, Sparks Construction, 771-1941
Application Circulation ate:
Date
Community a opment Department
Christine Di Iorio, Planning Manager
Public Works Department
Steve Speer, Seni(r/Engineer
Building and Safety Department
Mark Harold, Building and Safety Department Manager
Health Department
Date
Fire Department
Date
Schools Fees Paid
Date
Date
Date
4�
5
:.•
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PLUMBING FEES
tST FL
2ND FL.
POR.
GAR
BAR P
WALL
ESTIMATED CONSTRUCTION
Su FT ,r S
UNITS
ROUGH PLUMB,
'- -
SO. FT. •.$
YARD SPKLR SYSTEM
MOBILEHOME SVC.
SO. FT ,ri
BAR SINK
SO FT,d' POWER OUTLET
ROOF DRAINS
jp. FT t
DRAINAGE PIPING
SO FT Z
DRINKING FOUNTAIN
50 cT.
URINAL
VALUATION S
WATER PIPING
NOTE: Not to be uses as prooeny :ax +a:.anon
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL 64000
SIGN
WASHER(AUTONDISHI
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
=$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE. TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. c
BATH TUB
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SU. FT. RESID * 1 Y. c
SEWAGE DISPOSAL
"
SO.FT.GAR @ x:c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
JPERMiTFEE
ji
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING'
UNDERGROUND
A.C, UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINALl
OTHER APPJEOUIPI(
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
= PIua xf
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
'SPARK ARRESTOR
;GAR. FIREWALL
L,ATMING
MESH
INSULATIOWSOUND
FINISH GRADING
FINIAL INSPECTION
OFT. OCc,
PENCE FINAL
SIONATURLIlInK fIALS
QARDEN WALL FINAL