9609-066 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
1-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
rVj Professionals Code, and my License is in full force and effect.
p co License # Lic. Class Exp. Date
NU' LOt>v;6tl� �1 316!'
Z Date Signature of Contractor
CDOM
J OWNER -BUILDER DECLARATION
LL! LIJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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
LID
N Date Signature of Owner
ON
0)a WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
r IM
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O L Q Section 3700 of the Labor Code, for the performance of the work for which this
M Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
J (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 becomewsubject to the
workers' compensation laws of California,, and agree that if -1 should become
subject to the: workers' compensation provisions of -Section 3700 of the Labor
Code, I shall, forthwith -comply with those provisions. ;
Date: `' ' ' Applicant r
Warning: Failure to secure Workers' Compensation coverage is unlawful anc�
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize rep�sentatives of this City to enter upon
the above-mentioned property for in's ectiod purposes.
Signature (Owner/Ag nf) Date
w
PERMIT # CONTROL #
I
J��I% BUILDING PERMIT �'�°�m��° 4099
DATE JQO VALUATION �)M� 40� AX) LOT C+t >� tj5 TRACT �%c�
JOB SITE 73-90 R.Ai` CIR) A uiMIM A JA
APN 64u-370 0"
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER �}
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1 i 1 a )V 1' R 1 ,k • ct..� /1 41'11.111 1i
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). RAMi-14s ► iFv'� � � .
,'A QI 4NI'A (.'A 022.53
1,A Qt_fINTA ("A 922fi'A
IA 441
USE OF PERMIT
SIM AIV t`Ah ILN I)'WI1iI,t.IN( i'
f'ottNil j 14.1;..;10'VVF7rr AN c1RT W P11► I(,' ITA04'5 C;�F1>1'f' C(f
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1110t(CYiTl1;1`10 1 f 50) 8F
0ARAWCARPOWf 555,00 SF
F -S 1`!NINO,0 t'(}St f OF UN STA 71 1{ N
1.y'11�+f4'7.1WQ�
PUMIi IT 1'1'!1% `1' NIMAkli N
PLAN 04E K.1 I�� 101-000- 431-31$ is?`.'5.52
C:t }Y�i l ttJe i iuN i .El 101-000-4I.8-000 Sl9"�i.0)
MECHANICAL 10 i.-t)Gt1-421.s10 31) 130
01-K-11RICIAL F.U+" 101.000-00,000 $171.03
PLttNISIK-0 FLE 10140 -119 -ow $10.00
Sfy+NG M071014 I f1:;-1tkS1Ti 101-00U-241-000 319.1ii4
C' RA1) NO VT:i 101-11100-42:3-10 :520.01
fNJ'R,AS7'1itfC7PfRr,,FTE 27; 000-:141-341 84.149,7?
ART IN PLIBIAC PLACES RESW 701-0Ativ2a5�4
)W IN PUBLIi. PLACES W4F iff, 701 -000-255-WO 4226.fiA1
aCli -TOTAL AL cr�i�3;���1;i�L"i'I.t�t+i � �41� PI.�►N CHECK�
,�1 i 0
f,ESS PI�1i-�A{.1_f 1�N'��t
� 4226.01.2 :.
1'I',ftA1'ff FEES DUE NOW
$6,433.03
RECEIPT
DATE
BY
DATE FIN D
i
INSPE
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 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
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
w.
TYPE OF INSPECTION
DATE
INSP.
FOUNDATION & SETBACK
t�.Ff
FOOTING STEEL
IV
G�
MAIN GROUND SYSTEM
-
AA
�;-
:�
s CITY OF LA QUINTA
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
BUILDING & SAFETY DEPARTMENT
JOISTS & GIRDERS
777-7012
ELECTRICAL GROUND WORK
INSPECTION REQUEST LINE
777-7153 3
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN
SIGNED
Owner T.D. DESERT DEVELOPMENT LP
ContractorSPARKS CONSTRUCTION
Permit Number 9609-066
POST ON JOB IN CONSPICUOUS PLACE
.INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-960 RANCHO LA QUINTA;DR
!Y _
SFD PLAN 2 LOT 65 1996
TYPE OF INSPECTION
DATE
INSP.
FOUNDATION & SETBACK
4;z.
FOOTING STEEL
IV
G�
MAIN GROUND SYSTEM
GROUND PLUMBING
�;-
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN
SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
!Y _
BOND BEAM
O.K. TO WRAP
GROUT Cl 4' O 8'
FRAMING
�-
INSULATION
PRE -ROOF
G
COVER NO WORK UNTIL
ABOVE HAS 4EEN SIGNE
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
SEWERSEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1 �h TURN ON UTILITIES OR OCCUPY BUILDING
Desert -Sands Unified School District
Notice: 827879 Highway 111
Document Cannot Be Du licated Indio, CA 92201
P 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 10/9/96 APN # 646-370-004
No. 14914 Jurisdiction La Quinta
Owner Name T.D. Desert Development Permit #
N0.78960 Street Rancho La Quinta Dr. Lag #
City La Quinta zip 92253 Study Area 123
Tract # 27840 Lot # 65 Square Footage 2285
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 1.84 X 2,285 or $ 4,204.40
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 T. D. Desert Development Telephone -771-19;41
Name on the check .
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $4,:204.40
Check No. 9453
Signature Pal, �� nn o P9 Al A)O .&-
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