9609-064 (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 Exp. Date
Date Signature of Contractor
l✓
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.
( ) 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.
S"iKY9 F70KID 117149504
(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 agreelthat if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code„ I sha�Jorth�th comply with those•provisio s.
Date:'" ° Applicant
tr'
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 represeniptives of this City to enter upon
the above-mentioned property`for nspectio poses.
Signature (Owner/ ge19t) L .3 •' J 7 '
Date
/91117/1 -le BUILDING PERMIT PERMIT9#609-4)" CONTROL#
4097
DATE > VALUATION 11944.4li" .00 LOT W l[' 0 TRAC 440
73v-990 RAtV010 Wt, QUINTA OR
APN :6` 46471,402
ADDRITE
ESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1'tI ;N:S„?:%,fl, ")E'VE'1.r'f'h91:tf:'1,i'
St' ;!;'1i�t"�:*1.�"Ci:tIC' tdQ".
Po o Bux .1;16
�1,293 RANCHO IA QIJ.i.NTA 1A.
LA Q1,1111€'A 4.'A `11' 53
LA C,0191A, CA 92253
771.041
1,60071-1941 2"6
USE OF PERMIT
€i)MULI i t1A111.1 ltWh'.i,1.1i�1c_t
PLAN ?. V-1.i.ftAZA
111-4WT 1' FfIRS t'tf Y1,1WT AN ART IN r'1.1t IA, V!,tiCF3 C'R3rX"itT OF
$22602At 11REEMITNTW1111 !`.EVE IPfW%tN'P
t.'t t iii ?iV[ t:'ON;4'Y`R1,#t.'rilON -21291.00 SF
K)RCIVVAIO 115.00 3
a �ARAGITIC'.AR4'ORT 55' ,00 SF
ItSTI1Vfri"1` .0 C_Ci i'1' OF CONS'4'.gI `'TION
iSri1,a499.1�A
iF'11;C21IN^11I T FEF, SWOYfirl RY
PLAN 0TWX FIM 01-060-439,318 1''95.62
C"OAt:.MMIJCr10'N FTX J-03 -000-418-t3t111 5958.0
MECHANICAL FlYi , 111.1- W-41140) 5111.30
RTXCTR1CAJ- FFG 1014X)0 -420.0M $1,11.03
1'Lt'1*fI13t i+)t3 ;~:?E 101.000.419 -!?!t0 $160.00
ST 13G MOTION FU - the U $19.04
GRADING FEE 1.01-00.423.000 $20,00
1N'FRASTRilt:'T[JRF FF -0 215-000443-342 $4,249.79
ART R4 IsUBUC PLACE -12.04W 701-000-25548?{i $ry�ti.rs�
ART I N P1),Z1.L1C PLA,C:i;S - RE:SIC 701 -000 -255 -WO 4226W
SU3-TCYtA1. C0N1';f"RCI f[ON AND P A14 CRECK
$6,711.05
1.. NS 'PRG-€ AII)I FF S
-V226,01
TOTAL. PER1NUT 1?'EES DUE NOW
$6,45:I;l4J
RECEIPT
DATE
BY
DAjSFINAJ ED
, i/
INSPECTO
INSPECTION RECORD
:A 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
Final
Final
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)
97/68/1997' 16:52 619-771-1841.' SPARKS CONSTRUCTION PAGE 81.
�or 63
If7 ._
CITY OF LA QUINTA
yr 6A . & SAFETY DEPARTMENT
/ 777-7012
#MECTION REQUEST LINE
I G «<YYY 777-7153
-IT.D'DESERT DEVELOPMENT LP
ownerdor SPARKS CONSTRUCTION
Nus 9609-064
POST ON JOB IN NSPI UOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
t 7 7 t los nOoaEss 78-980 RANCHO LA QUINtA DR
SFD PLAN 2 LOT 63
6dI
O J �Q/ TYPE OF INSPECTION DATE IN130:
Tr�P FOUNDAT10N A SETB1lCK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
l �""� "C� f ' ` �v PRE-GUNITE ,
o �
4
i
DO NOT POUR. CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOIBT8 & GIRDERS
ELECTRICAL GROUND WORK
f DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH GAS 6 GAS TEST S Lf
HEATING S VENT - AIC .
O.K. TO WRAP
1 -2pil l- -1, IKO
GROUT Q 4' ❑ 8'
FRAMING
- -
INSULATION
` of
PRE -ROOF
COVER NO WORK UNTIL ABOV MAS BEEN SIGNED
DRYWALL INTERIOR
l �,
EXTERIOR LATH
.• G �
POOL PRE PLASTER
POOL FENCE & GATE
EFLSEPTICTANK
FINALS
ELECTRICAL 1 5 =- Gl I tore' -t
FINAL GAS TEST
HEATING -A/C
HOUSE NUMBERS
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES Ola OCCUPY BUILDING
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 10/9/96 APN # 646-370-002
r•No. 14912 Jurisdiction La Quinta
Owner Name T.D. DesertDevelopment Per mit #
No. 78980' Street Rancho La Quinta Dr. Log #
City La Quinta zip 92253 Study Area 123
Tract # 27840 Lot # 63 . Square Footage •2285
1
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 0ccupFncy for
this square footage in this proposed project may now be issued.
Fees Paid By T.D. Desert Development Telephone;�771-1°941
Name on the check -
By Dr. Carol McGrew
Administrator in Charge ' • �. °r.,
Fee collected /exempted by Pauline Pearson Payment Received $4.204.40
Check No. 9453
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
.l
1