9609-070 (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
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"ft�7 FUND 137t4ty504
(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 should become
subject to thefworkers' compensation provisions of"Sectionn337100 of the,Labor
Code, I shall;ferth•wifh comply with thosP�provisions. f
Date: 12' r ��''Applicant i- —'r 9
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null• and void if
work is not commenced within 180 days from date of issuance of such.
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon,
the above-mentioned property for inspectionipurposesi 1
• �--
Signature (Owner/A'un't) `�' Date
�D BUILDING PERMIT PERM' 9"9 070 CONTROL#
(//J�
0*190J09.041 4103
DATE � #!% VALUATION LOT IA:f 3 69 TRACT+ 40
JOB SITE 78-#241 .rr�iol.•.HO LA 4�1 NTei-01i
APN 646-370-003
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
S�U�4%, Crlt,rc I.It, jCr1ON
tt.; �. i.�u t
,t� 9 RANCHO1 A r UIN C DR.
LA 00l1r!'i'.A (,'A, 97253
LA. QCJ1MI A CA 92253
7'7I•t�fr11
sti1 X771-IO/41 r..f$L# 2+?s1t.
USE OF PERMIT
titltif,:l(.,%i 1/A141l1..1' i�Mrrt,l„l�tEf
PLAN 27: 1KRAZA
f'lrClAft'1' '''�I3 3. t F'i. ti`7' Afv #SRT PW['(,TiBJ W PLACES CRIEDIT OF
3;, 20.021'. IR ACIREE Nll3]°+T WITH (70MMUN(T Y1:0FVF1,0PA Csl I'
f.."tl�"9'C��f: lY")N.�i't'P.(iC"'! iC�Ti 2,2t3S.+10 SI•
OAI.2AGWCAI2PORT 555.0g SI'
YIS'i'1MA ED CUST Ola CONS'I-RUC"ON
.1%),409.011
I'IMMIT PIKE SUMMARY
11t, AN C1i1"Ck FEE 1Q1 -L +139-�,'i.3 i05. M
CCrNSTRUC."I`. N 1,19 IU140-418-ow
NIRCHANIC:
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 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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
'
06/27/1997 13:37 619-771-1841
PARKS CONSTRUCTION PAGE 01
.I,
"
CITY OF LA OUINTA .
BUILDING A SAFETY DEPARTMENT
hey
777-7012
INSPECTION ON REQUEST. LINE
masa
f
ownw T.D. DESERT DEVELOPMENT LP
_
o17t .` J v�h Q7�IOH�'
ContreawSPA►RKS CONSTRUCTION
PrKmlt Nu~ 9609 070
L POST ON JOB INC N ICUOUS PLACE �
INSPECTOR MUST SIGN ALL APPLICABLE SPACES__
�J a,JOB
ADDRESS 78-920 RANCHO LA QUINTA DR
SFD PLAN 2 LOT 69 t : i 0
TYPE Of IN3Ve(',iION OATi INSP.
DO NOT POUR CONCRETE UNTIL AL AB VE HAS 8 E SIGNED
CONCRETE SLAB / (1
JOIBTS 8 GIRDERS
ELECTRICAL GROUND WORK
00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS A GAS TEST
HEATING A VENT= NC
FIREPLACE
ROOF i
BOND BEAM
O.K. TO WRAP -
GROUT O 4, O e'
PAE-ROOF
FINALS
ELECTRICAL
PLUMBING
FINAL G" TEST
TEMP POWER -- -�
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON, UTILITIES OR OCCUPY BUILDING
Notice:
Document Cannot Be Duplicated
Date 10/9/96
' No. 14918
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201 '
' 619-775'-3500 ,.
CERTIFICATE OF COMPLIANCE
APN # 646-370-008
Jurisdiction La Quinta
Owner Name T.D. Desert Development Permit #
No. 78.920 Street Rancho La Quinta Dr. Lcg #
City La Quinta zip 92253 Study A --ea 123
Tract # 27840 Lot # 69 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 771-1941
Name on the check
By Dr. Carol McGrew tC
Administrator in Charge i
Fee collected /exempted by Pauline Pearson Payment Received $4,04.40
�
' Check No. 9453
ifs
Signature S I� dt Qon� 0 �A-AA Z/vL_
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