9609-068 (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
Profession+ls Code, and my License is in full force and effect.
ricense # y' Lic. Class /'Ekp Date
f �
Date r`? 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.
( ) 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.
,VAT F1:1ND F371045r9-4
(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 if should become
subject to theworkers' compensation, p%visionsof Section 3700 of the Labor
Code, I shall'o t6wilh comply with those provisions: r
Date:;' %.., Applicant—
Warning:
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 representatives of this City to enter upon
the above-mentioned property for inspectiori puposes. �+
Signature (Owner/Agent) t % ; Date z l�
PERMIT# CONTROL#
L.� BUILDING PERMIT 9600-06
41, 01
DATE �i < 96 VALUATION X 11� OP),00 LOT I ,{ .) Il' 61 TRACTA40
JOB SITE 78-!40 KAI6NCHO LA t UIN UiVOK
APN 646-•37041416
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
St' RIK,`.';
Fc.; B01'. i 710
79293 RANCkO [,AQUTHTEA D&
LA QUINf'A t."A 92251
1.,A QtJ1KYA CA 92251
771 inif
ttil�>'t77t-IW13 C.�I?I,!'� 2
USE OF PERMIT
,�ilNc..31.t..1°'tAA111,) 1�L1!.til,l.{IVi
PL AN 21"F FdtAZ A
f'I S2Fki�'f f' x;Ji.�i fi0.11".Vell' #kN ARR T IN I'I11 LFC i'I..Jtf`f?;i t:'f 1 t.9tT' r ?}
$226 02 PFR A01MMIMENI' 'WITH ("t'WJ4iLizti JITY 1"►1?AV01t3F>MEW
C:°1.!g'I't�tY,t �`{'>N�t"i'Ft1 ic"Ptt:.►T�i i, `85.b0 SE'
1��RP" 11lPiA"F'1t1 F 15,00 ,y['
GAP001EK'ARPOR T k5S.04 SFr
F.S I":IMAT0,11) f QVr OP CF.INSTRtl)C"7'ION
190.4 9.00
PERNIfT FEE SUMMARY
PLAN 04Er..' K F UM 101 -OW -439-311"S 3 79 5, 2
CONSTRUCT ION k 111 101.000 iii$ -OW S53i►.fh�
WCHANICAL r Tl 1014)00�421.000 �1.tF,St3
111,R' 'MIC'Al :'FFF 101.000 -VO. -000 $171.08
tiTONG NIOTWN FM - RL'SJF 101.000.241.000 $49.414
0 R,AI)IN0! ET-, 101-000-423,000 $2000
1NFRAIX MI. K717LW,. Flip $1.249.79
ART IN IIf.3133.IC'MAC;TS 1,'RUSIC -7101[-WO-255-WO S, 2 02
r
Alii' 1N PUBLIC MfAC a - REM' 701 -000 -253 -ON
SUR-#Y.1'`i s -AL CON.: i RUO1' ON AND PLAN C1' E( iC.
$6,711.03
LESS Pksr PA-11)FEES
-:1226.02
TCli'AL PERMIT FEES l'�UE'rtOW
RECEIPT
DATE
BY
DAI�EfiNAL�
INSPECTO
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:
,1'67'(,7
a
5 s CITY OF LA QUANTA
•.o, a BUILDING & SAFETY DEPARTMENT
t�tzyt • 777-7012
INSPECTION REQUEST LINE
777-7153
Owner T.D. DESERT DEVELOPMENT LP
Contractor SPARKS CONSTRUCTION
Permit Number 9609-068
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-940 RANCHO I,AQMT.A DR
SFD PLAN 2 LOT 67
-�aNr7 rr:�—
TYPE OF INSPECTION
DATE INSP.
ray
,1'67'(,7
a
5 s CITY OF LA QUANTA
•.o, a BUILDING & SAFETY DEPARTMENT
t�tzyt • 777-7012
INSPECTION REQUEST LINE
777-7153
Owner T.D. DESERT DEVELOPMENT LP
Contractor SPARKS CONSTRUCTION
Permit Number 9609-068
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-940 RANCHO I,AQMT.A DR
SFD PLAN 2 LOT 67
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST I
HEATING - A/C I
HOUSE NUMBERS
JOB COMPLETED i
TEMP POWER
A.80VE APPROVALS DO NOT INCLUDE RIGHT TO
1.96 TURN ON UTILITIES OR OCCUPY BUILDING
-�aNr7 rr:�—
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
Vok
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALLABOVE 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
S
HEATING & VENT - A/C
FIREPLACE
ROOF
/- G
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
- (�
INSULATION
G�
PRE -ROOF
7-1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
(• `7
EXTERIOR LATH
POOL PRE PLASTER
ENCE & GATE
SEWEA SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST I
HEATING - A/C I
HOUSE NUMBERS
JOB COMPLETED i
TEMP POWER
A.80VE APPROVALS DO NOT INCLUDE RIGHT TO
1.96 TURN ON UTILITIES OR 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 # 646-370-006
No. 14916 Jurisdiction La Quinta
Owner Name T.D. Desert Development Permit #
No..78940 Street Rancho La Quinta Dr. Log #
City La Quinta zip 92253 Study Area 123
Tract # 27840 Lot # 67 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 'abooe-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 OccupEncy for
this square footage in this proposed project may now.be issued.
Fees Paid By T. D. Desert Development Telephone 771-1941
Name on the check _
By Dr, Carol McGrew ,
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $4204.40
Check No. 9453
Signature, Qan:« 1. �m�ivAAyyv` "
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