9711-004 (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
706410 B 1 11y)
,/Date ` ��f Signature of Contrajc4o°r.��A-
g
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.
KI 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.
[))l1i'Y4�14
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 I should become
subject to the workers' compensation provisions_ of Section 3700 of the Labor
Code, I sh II fol'thwith comply with those provisions./
Dater IG
Applicant s/t >/i AIe 1a,J Av
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 l/
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 inspe�urposes.
srinature (Owner/Agent)I�/�r�� f " �AA Date
PERMT# . °°NTR°`#
BUILDING PERMIT
1711-04146
�i A
DATE VALUATION �' LOT' TRACT 63,
Iq6 !a
ADDRESS JOB SITE!t 74455 �'�.1NA FXZ10 .,ANE N0101-1,APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'f ill, PIN �'Ca�l:�:1''�IJC'E`l��;; CO
iUI:F'l�j �'t�P!'>5`�`�:tJc�ttt '��: Col.
50,46 tii.3QA1, ciu. x
78120 t.;Af,i. E i4rte.1YD #206
LA OPINTA CA. 9'2253
I. A. QLi N'FA Cry 9225:1
USE OF PERMIT
W i
CU3T%0*&1 CONSTRUCTION 51,830,01) JF
09.00 3F
AIR t�cf,1VCA 14R'itt'1' SIS
''spawftw C;rwr or t:,(v4s 4. zv .,.rj.o
PERMIT F f?'% SUMMARY
C014S'M)CFION:hEE X01 -t N)-418-000
Pl,-kN r,F{t,Ct; rctu lt1l-fl{?0-439�31It �v r,��1. 1i
!LICA; 6%N-IfLIA-i..F'Fs; f01-{3()04112'1-fl00 St9 .st
i:1;CIlta ;Ar. I: 1fit-K"20_000
PL(MVIBIN1017VA, 101-000-419_000 1A0
t'rj'{ONCiM(YFi4IX Ff?ri - RHIMD 101 -MO -?41 -OM
41RA1)1N0 FTEZ 101.0011-413.000
1N1�RA_11';M1C'fl0kV FEE" 221°4300443- 4 Eti;t9il�f.Ov
Al f' IN KTOL [C' PLACES - IaE3JC 701-000.2554k0 $y49.'1f
FEE 17f?f'(,^)S i' _�1r/u3C}.41U
i
S#,ftp-'r3:At, f t3�3�,T'ii) f:1Q�i �1N1�d'.A�+l CHKK
/ LESS PRE -('AID VI.I S
-SLOAM'D)
x,
RECEIPT
DATE i�
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
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
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
r
t
Final
trltility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
f
Notice: 82-879 Highway 111
. 01
2 92
Document Cannot Be Duplicated Indio, C619 -77A A 922
00
CERTIFICATE OF COMPLIANCE
. }
Date 1/27/98
No. 16554 Jurisdiction
LF
APN # 761-522-001
Owner NameTurpin Construction Permit #
No. 78-120 Street Calle Estado Log #
City La Quinta Zip 92253 Study Area
Tract #
Lot #
Square Footage 5880
Type of Development Single Family Residence . No. of Units 1
By
Comments
Paid with a cashiers check . and the balance in cash o .
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 5,880 or $ 10,819.20the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
'k
Fees Paid By cc/First Community Bank and Cash Telephone 760-777-7611
Name on the check
Dr. Doris •Wilson
Superintendent
Fee collected /exempted by
Olivia Aguirre
Payment Received $10,819.20
Check No. 076171 .
Signature'
NOTICE: 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
above 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
collect them on the Dislrict('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
REGISTERED INSPECTOR'S WEEKLY REPORT
1 .
a'1
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE .STRUCT. STEEL ASSEMBLY O
❑ POST TENSIONED CONCRETE O ASSPHALT 'OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING=�"'��F'�I
JOB LOCATIONr"% t o 1 �
REPORT SEQUENCE N0. .
TYPE OF STPR TUB{
PERMIT NO.
E
DAY OF WEEK
'HRS.
MATERIA
DES IPTC
ttt���GGGGGG
ARCHITECT
INSPECTOR
CHARGED
E-�IT- If I
ENGINEER
ASSISTANTS
HRS. CHARGED
DATE INSPECTION CONTRACTOR- GENEU N J NS • CONTRACTOR
04- B Ase– pt 61 . 70 00 Cow —.
r
�Z7 ems_
COPY SENT TO CLIEN
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE /
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY SIGNATURE OF REGISTERE NSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE s'
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS. DATE OF REPORT REGISTER NUMBER