9609-069 (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
_ b1
s
Date's 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:
Cartier Policy No.
Xf'ATE P'U`Nf) -
1,17 )119541
(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 I shVd become
subject to the workers' compensation provisions of -Section3700 of the Labor
Code, I shall forthwith comply with those provisions.
Datd,7/,-1 li % 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 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 f&r,inspection purposes.
.,
Signature (Owner/Age t) Date -'-��
ABUILDING PERMIT PERMI - CONTROL#
s > s4.:Sil 1'csr (59 ' 4102
DATE VALUATION' , LOT TRACT
JOB SITE 78-�)36 }lilN`.fiiO LA i);AN-VA .DK
APN 446-370-007
ADDRESS
'OWNER
CONTRACTOR DESIGNER ENGINEER
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SPA 11XS LONiVUi110N
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73295ICAN f O Ltd QLilN A DR.
LA,Ql, Onn-JA (,,'A 92¢251
LA,QUINTA CA 92253
771.1941
CB114- 2,9W
I I,SF nF PFRMIT
SfNCH.f F.AN41L':i:;)Wt~i3ONG
P1MM11`f" fTTr1U* f0i(11,h:!:'I' AN ART IN Of
$21-3.95 Plsf>. A13ttl?.f4?:d7 \'v`?'1"f f s:(+ilrti4l:TNi!'1' i?7s1J3 01idC
(A tS ('r' M C(.V4S1RU(.7f KsN 2.231.0 SP
M.ftOt:r/4?tAT.10 170.00 9f
(:ARtAG'IT ;ARP()RT 496.00 SIT
VN'i'lfliEl,'fED C:C)+; f OF C ON;4'tlWIt"i'f0N
Pi+.4t1'1.7r T FEE 81Y)14i1IARY
PI -01 CM-:CK1--FE 101-000-3.39-318 $734.31
CONST RUCTION FT39 101-000.419-000 S94CJ.S0
fll ICHA1N.1CAL F(M 9R.N)
T(FC31t(CAL Ful. $fr'j7.81
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ORAOT NO FH:i !(11-000-423.000 S"(►,00
ft4mA.471',(JC;TTIRF1--FE 225y(NW-143f-342 $4,1N.71
AR: r fP! !vw,ic !�L,kma - Ho., , 701-(loo.255-wo $215 K'�,
MIT (i3PUBLIC* PL ACTES - RUS r(1:, 101 -OW -255.000 4213.93
,
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$6,500.P
1.k;SC ( k -PAID FUS
4213,95
! (YfAt, -FERNOT FE1. S INVIF NOW
S&,285.52
RECEIPT
DATE
1 BY
DAT FIN LED
INSPECTOR
v
�4
INSPECTION RECORD
OPERATION j
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
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
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)
. - CITY OF LA QUINTA
i
Of ° BUILDING & SAFETY DEPARTMENT '
777-7012
INSPECTION REQUEST LINE
" 777-7153
OwnerT.D. DESERT DEVELOPMENT LP
Contractor SPARKS CONSTRUCTION
i . Permit Number 9609-069
POST ON BINC CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES I
JOB ADDRESS 78-930 RANCHO I;AF QLfiWA DR
' SFD PLAN 1 LOT 68 1996
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL /. Gj
MAIN GROUND SYSTEM }
j
GROUND PLUMBING o• '
PRE-GUNITE • :
a
DO NOT POUR CONCRETE UNTIL ALL BO E HAS 8 EtO SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED 3
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C '
FIREPLACE #.
ROOF (�
BOND BEAM.
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION -
PRE -ROOF
12
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR cl
EXTERIOR LATH
POOL PRE PLASTER
POOL. NCE & GATE
SEWER EPTIC TANK 672 9
FINALS -
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE 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 # •546-3170-007
No. 14917 Jurisdiction La.Quinta `
Owner Name T.D. Desert Development Permit #
No.78930 Street Rancho La Quinta Dr. Log #
City La Quinta zip 92253 Study Area 123
Tract # 27840 : Lot # 68 ,.. Square Footage 2231
Type of Development Single Family Residence =140. 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 abov=e -named owner is
exempt from.paying school fees at this time due to the following reason:
r
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.84 X 2,231 or $ 4,105.04
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: 771-1941
Name on the check j �r
By Dr. Carol McGrew.
Administrator in Charge `
Fee collected /exempted by Pauline Pearson Payment Received $4,105.04 ,
Check No. < 9453
Signature Q�P Q11/1X1&-vk_
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