9812-068 (SFD)LICENSED CONTRACTOR DECLARATION
1,here0y.affirm under penalty of perjury that l am licensed under provisions of
Cha0ter'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
"r��l3fics i 8 ,.,,12/3 199
,"Pate , Signature of Contractor
OWNER -BUILDER DECLARATION!Co`ntractor's
I hereby affirm under penalty of perjury tba� am exempt fro
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 offejdd 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),
O 1 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 conset 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.
(This section need not be completed if the permit valuation is for $100.00 or less).
(-1 .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 the workers' compensation pr visions of Section 700 of.•t � e�babor
Code, I'shall forthwith comply with those pro i'sions
Date: Applicant �� f✓�r�'
Warning: Failure to secure Workers' Compensation cofierage is unlawful and
shall subject an employer to efminal penalties and cidfines up to $100,000, in
addition to the cost of comp5psation, damages as provided for in Section 3706
of the Labor'Code, interest°and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
Whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
-:work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this -City to enter upon
the above-mentioned property for inspection purposes.
� .
_� ignature (Owner/Agent) �� -a� f � Date a -�-•,)
PERMIT #
BUILDING PERMIT
.. 981241"
DATE 719q VALUATION S11J0,#t1.at:5 LOT �� TRACTJOB
SITE
ADDRESS 7&��4.5 AVENIDA, LA x O. .RS
APN 7>694..4.4-005
OWNER
CONTRACTOR/DESIGNER/ENGINEER
tvO:tZ.i.,!" DFV�,'L1.JPXIEi a A INIC
WOW.D , V lei OPMH-;s�T, IN -IC
Pq'BO 1328 '
PO:BOXXI 13287
PALM DES.1<lth' CA 92255
PAL(Y1.U1:8FSWr CA.
�rcal�7�j. 7� CSL# V28
USE OF PERMIT
S:la'�'e iU FA:!%1i.i,Y 1.iIWEL.UNGY
SFO -- PtMIT DOES NOT I'iq'C1.UM FIWL.
TRAC ' C: Nt S7RUC'TION Z078.00 S
P0RCI]WATIO 92.U0
GA1.tEVC't.FXA:i2P01 1'
BLCK'K WALL (F1,9'ILF) �,3t36t.�S
ESTI i iX ED Lam.'9T OF CONI S RUC;itRYN
1301311111.015
9:'Yt'.lf€NIff FEE S UAIltARV
CON I ftUCTICYN IEE 101-660-08-000 ► 4$.t3s�
j t
PJ:..=ani +'"sRrK FEE,. t0l-t. O-439_„►18
MA DEfI'01Ii'
MKC&ANICAL FEE 101-0170-421-000 W.W
FLEC'U11CAL FEE 101-000-420.000 $148.59
pywrAIN(I F'Hr 1101-Ofil`►.40-000 $L3C(10
rrz,,011G NicnolaN t 3:-1krivo .101-000.211.- W, $13.01
usc.ADWO FEE 110140 )42.3-000 $20X1
£ :1�42A.g'1 R1 K 'i Ikis l lsks `?254)O 1.44:V- 42 S' ,81 Lia
t
f RV(71fK(-' [n,AN 1.0140(} - 'tit 1-311.5 $100-oo
MU lid' 1'U811C PLACES - K31L 701I. -MID -255-000 $77,03
SUB-"1'd..aIlid,, 0-i, M.ZI'.1tUCTION AND PLAN ("KXX
$4,735,W
1 EM PRE-N11.D .FEES
_$11150.00
TOT,41 4°4. CART FEM 3)VE NOW
$4,485.00
Rt `EIPt,
BY
DATE FINALED
INSPECTOR
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 —Q ?
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath —
Drywall - Int. Lath . Z—
Final
Final
BLOCKWALL AP ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Ficial
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 — -7 — q
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) 7?
COMMENTS: -
Notice:
Document Cannot Be Duplicated
Date 3/2/99
No. 18410
Owner NameWorld Development
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Jurisdiction
N0.78705 Street Avenida La Torres
City La Quinta zip 92260
APN # 769-144-006
La Quinta
Permit #
Log #
Study Area
Tract # Lot # Square Footage 2078 ,
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:
a
EXEMPTION NOT APPLICABLE;
. Government Code 53080 in the amount of_
.This certifies that school facility fees imposed pursuant to ,�
1.93 X 2,078 or $ 4,010.54 the property listed above and that buildings` +-
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By ccNalley Indepdend. Bank/World Development Telephone 771-5571
Name'on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto
1
Signature
Payment Received $4,010.54
Check No. .188278
IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
ollect them on the District('s)(s') behalf, whichever is earlier.
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 .
Dear Builder:
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
Prior to issuance of a building permit, you will be required to obtain clearance from the
Public Works Department for one, or more, of the following:
1. Verification that rough grading is complete, and the pad elevation certifications
prepared -by a licensed surveyor, or engineer, are on file in the Public Works
Department.
2. Verification that infrastructure improvements and other required tract improvements
are complete, or sufficiently advanced to warrant building permit issuance. .
3. Prepare an engineered grading plan that provides for on -lot storm water retention,
and have it checked and approved by the Public Works Department..
Tract 26524 (Estancias)
• Tract 26769 (Mountai-i View Estates)
4. Prepare an engineered grading p. an that provides for building pad grading in
accordance with the existing soils report and tract grading plan, and have it
checked and approved by the Publ c Works Department.
Tract 28034 (South Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT: (%a/_ -e1 cza
LO
PUBLIC WORK RIZATION DA E
FA0WDEPTIDOCSIFORMS\PW CLEARANCE LETTER.ss