9607-044 (AR)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
N co Professionals Code, and my License is in full force and effect.
p Ch License.Lic. Class Exp. Date, ,
0 r ;'1L4 113 W
Z NDateSignature of Contractorf -�
r 0
CO () — OWNER -BUILDER DECLARATIQO
W W 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
N Date Signature of Owner
O QN,
0- Q WORKER'S COMPENSATION DECLARATION
> � I hereby affirm under penalty of perjury one of the following declarations:
Lo FZ 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �L- compensation, as provided for by Section 3700 of the Labor Code, for the
0� Q performance of the work for which this permit is issued.
CD Q(�) 1 have and will maintain workers' compensation insurance, as required by
0 C Q Section 3�9%,gfkth k)l,abor Code, for the performance of tP.9,%vy9r�k;,for which this
CLLO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
Cb 5
r, 0
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 become subject to the
workers' compensation laws of California, a"ree that if I should become
subject to "P.e workers' compensation -prove ions of Section 3700 of he Labor
Code, s II fo h th comply with those�vi Ions.
Date: Applicant
Applicant
Warning: F� secure Workers' Compeny�ation 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
opplieatiorl.
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 represents Yes of this City to enter upon
the above-mentioned property,foT. nspeZ 'on urpbses.
Signature (Own eiyAg Date eo-13'
CONTROL#
BUILDING PERMIT PERMIT607-044
3951
DATE 9111% VALUATION :1+10;9()6.11110 LOT TRACT
JOB SITE V -19'i itiAC4CHV (,,A QU 0 tA.UK
APN
o—OWNADDRESS / _ )7o—
OWNER
ER
CONTRACTOR / DESIGNER / ENGINEER
JON ZS
SPARKS C ONS"1' UC;T1ON
79-2151U�NCHO LA QUI NTA DR
'79295 RANCHO LXQUINTA DR.
LA QtJ1N'rtl CA (>'1253
LA QUINTA CA 92253
019777 (+141 C11LO 23M16
USE OF PERMIT
k � SI �i��t'iie� 1, fl c31,11`l'tiat�
-
1KNI.ARf,1f„%AMJI Y 11<.OM
.n 6ti!Y:a�a <'"•f':n�i!'e'e)1 ii'"i 'i i `; eM�t rf
WSTUNIAT.ED WST OF CO N91'RU1.~riON
11F1i.1 UT .FE11, SUMMARY
Pf-AN C'ki1+rX x'1.11 101-00"39_318 i S1.4ffi
CON1STIMUlr'1'IuK r s 101.-0001:18-M $126,00
N1130ie1NICAl:.1'rrl 101-000.421••000 $111.00
1ILEC 'i'it f C AL 141IR 101 -(M-420AD00 $11.90
PLUMBING FFR 101 -000419 -WO $18.00
_
3T0Nt, N1011 ON f U, E , RS -,,H) 1101 -OW -211-000 $1.09
SUBI-TOTAL. COldS"TR.CIC' ON AIND PL N, CI4CCK
LESS 11R.E-PAIL) FR1:S
$0.00
T YfAt,1'K1ti1' IT f CES r UF,' NOW
5261.89
96
RECEIPT
DATE
BY
DATE FINALED
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 Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath _ Q rp —7—
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 I 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
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:
Desert Sands'Unified 8ch_oo1bistrict
4
Notice: 82-879 Highway 111
Document Cannot Be Duplieated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 9/12/96 APN # 649-370-006
No. 14847 Jurisdiction La Quinta
Owner Name T.D. Desert Development Ltd. Permit #
No. 79195 street Rancho La. Quinta Dr. Log #
City La Quinta'. zip 92253 Study Area �a 3
Tract # Lot # Square Footage 140
Type of Development New Residential Addition No. of Units. 1
Comments Enlarge tamily room.
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 Government Code: 53080
in the amount of 1.84 X 140 or $ 257.60
the property listed above and that building permits and/or Certificates of OccupEncy.for
this square footage in this proposed project may now be issued.
Fees Paid By T.D.Desert Development, LTD. Telephone- 771-1941
y
Name on the check
By Dr. Carol McGrew
Administrator in Charge y
Fee collected /exempted by Pauline Pearson Payment Received $25.7:60
Check No. 9275
Signature
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
I