9609-072 (SFD)t LICENSED CONTRACTOR DECLARATION
(n 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
CV w Professionals Code, and my License is in full force and effect.
p Z) co License # Lic. Class Exp. Date
d LO
(�Z f j 19, i
W ' rte
Z� Dated Signature of Contractor,_
O r
CD U 0)OWNER-BUILDERDECLARATION
W d (n 1 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).
cr) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
Z WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
p () 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
O J. Q performance of the work for which this permit is issued.
C0 Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d F- permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
O 5fi7A'1I3 i'!114Ii 3571+ "94
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, and agreelfhat if I should become
3 subject to the workers' compensation provisions�S ctlon 370�he-- bor
Code, I shall forthw'th comply with those provisions.
Date: -1(1 '7 ?7 LlApplicant t
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
dNplii;8liui I. -
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 inspection'purposes. /J
Signature (Owner/AZjent) �-- �'Qatet
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BUILDING PERMIT PERMIT# CONTRbL#
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DATE 6 VALUATION S01.401.00 LOT !101' T I TRAbT,'�to
JOB SITE Tri x404 RAN(.' 10 i'A 1pci u A.1*
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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103 RANIC'140 1A QUINTE1. J'A.
IA Q1 f1rITA ('A . +1�1.��
i,A QC,ilNIA CA (17253
771 19.11
W 0071-1041 206
USE OF PERMIT
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MART RT FF3e, NUMAI ARY
PLAN C; W1,7K FM 62
t,t±i`1s1i�1l� "I'iVv Flit
1MKC°IIt LAICAL t'.h : 1t)1-OOt1-4 :I-f10I1 $!I1,Sf1
Ft' Cr i'12TCAL FEF 10.1.000-420.000 S1,71.03
F1,Lt9e wo, I° ; 1 A 1-000-1114-aw S 1610,.�o
N I'C31 G INi0 1c:rN FER - kt-8iri) 101 At")(iU' 2241-000 S19-04
c.RAi`1im; r*!x 1014AW-423-'000 $20,00
(NI1 R.A`i'1 RUC!TURF PEsF, 22 5-0 0-14.3-142 54,20, 79
t' TF IN 3';IBL.TC PLAN; ES ' REJ31111 701 -WO -n55 -W0 5226.02
s1,RT U4 PL%*LW PLACES 14-31L 701-000-2"55-01 4226.02
111 88 PRY'' -PAID N1s :S
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RECEIPT
DATE
BY
DATFFIOAtEDINSPEC
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 Wail 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 Pibg. 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:
r
- --
s CITY OF LA QUINTA
ell
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE i
777-7153
Owner T.D. DESERT DEVELOPMENT LP j
Contractor SPARKS CONSTRUCTION
Permit Number 9609-072
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-900 RANCHO LA:.,G, UI:NTA DR
SFD PLAN 2 LOT 71
TYPE OF INSPECTION DATE INSP.
FOUNDATION'& SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING -
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE 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 —L _
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ g'
FRAMING
INSULATION -
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR j ,i 17 � I47
EXTERIOR LATH _' r
POOL PRE PLASTER
P�QL`ti ENCE & GATE
SEWE4 SEPTIC TANK I 5 � T�Tv-
FINALS
ELECTRICAL
PLUMBING /
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS j
JOB COMPLETED !
TEMP POWER !I
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
i./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 # 546-370.-010: .
No. 14920 Jurisdiction La Quinta
Owner.Name T.D. Desert Development Permit #
No. 78900 Street Rancho La Quinta Dr. Lc g #
City La Quinta Zip92253. Study Area 123
Tract # 27840, Lot # 71 Square Footage 2285
Type of Development Single Family Residence ivo. 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
4 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
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $4,204.40
Check No. 9453
Signature 1\t F4 �a Q�nn e P�At
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
1