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9510-048 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm 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. '706410 B `+131/97 License #_ Lk. Class Exp. Date Date Signatureof Contractor OWNER -BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason: r () 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. (This sectidntriWd rio"t{i3a, ompleted if the permit valuati6rfl &e$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 shall forthwith comply with those provisions. Date: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. ' IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 186 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to,the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Dade A"' PERMIT PERMIT�� ;r _ _ _.BUILDING �'Sf DATE erry r;+a VALUATION ` •rwaa. �•�•�� LOT TRACT .i9 JOB SITE ADDRESS 7,9-,56j1 )aj A 0 L VAXO_ TH APN OWNER CONTRACTOR 7JRPiN CONSTRUCT[ON CO. LA. QUfN"l"A OCOL F P1 OP13 5493$ SHQ.A . CREEK 79 -560 TOM FAZIO LANE NORTH I..A QUINTA CA 92253 LAQUINI'A CA 92253 (619)7.77-7611 CBL# 3751 (619)977-11.04) DESIGNER/ENGINEER y+" 13A1?1TAT "rd l0 APOC"1;7N(`a 1�t USE OF PERMIT��►'1 X"C1J.vl1 . !l V L Ll.sil INDIAN W.M.,LS, CA 92210 S1.412048 +�.t�� w ��ti '11C 'JA." i�ll/1L� Y .a. PM- 41T L)OE'i NOT INCLUDE BLOCK WALLS M,POOL. FEE DESCRIPTION FEES CU3!' M CONSTRt,IC ION 4,698.00 IA-' GALLAOi; CARPORT 898.00 SF 1� STJMM ED COST OF CONS T RI T MON 383,375.0 ' .1'I RAJ Iff FEE SI)MNLA.1 Y MAI CHECK F 68 101.000-439-3113. �1,3:18.5fi CONSTRUCwL'9ONVEL, 101-000418-000 $1,63:3.50 MEC IANI:CAL FEE 101 -000 -421 -OW 6143.011 R,1?C'i'!27CA7. JMFI 1010-q-420-000 1'1.,iJ1UMIC1 :' 101-Ob0 4:1.:1-Q00 $26554► TONG MOTION F rE-,PXS)D 100-000-241-000 538,36 OLiADI—NO PILE 101-000-X123-000 $20.80 INP'R;i t'i'ititC:'3,`1IME FFIR,_ 1234M44-1-1-42 rF;(311 oo AIRT IN OMLIC PLAC1aS-12ES1D 701-000-255,000 670S."' k, 5'Ul 403:AL CONSTRUCTION AND PLAIN CHECK. $10,421.75 LESS PRE -PAID FEES 4250.00 TOTAL PERMIT FEES DLi.E NOW '1"'i37f`AL PRaJEC f PERMFF FEES �Jt41,17A.7� 0 1995 1fi,42S..75 1f j REC DATE BY DATE RNALED 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 G 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 CfS Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: lY a .3 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole MKI 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 QUINTI4 �oBUILDING & SAFETY DEPARTMENT 7774012 INSPECTION REQUEST LINE . 777-7153 LA QUINTA GOLF PROPE ` ITi ` F U� QUWTA Owner f Contractor, , 77��7_c� J 19 PermitNumber I`'MANIC POST ON JOB IN CONSPICUOUS PLA a INSPECTOR MUST SIGN ALL APPLICABLE SPACES j JOB ADDRESS j SFD. PER11M DOES NOT INCLUDE BLOCK, WALL OR POOL. TYPE Of,INSPECTION' DATE INSR FOUNDATIONAISET13ACK` /_) ../9 • Clt-- I /SUS OTING STEEL - ,IN GROUND SYSTEM OUND.PLUMBING E-'GUNITE -"r , I;NOT.POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIG iNCRETE SLAB ISTS & GIRDERS _ ECTRICAL GROUND WORK I NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIG ROUGH PLUMBING 4 ROUGH GAS & GAS TE i HEATING & VENT- A/C FIREPLACE } ROOF BOND BEAM ( O.K. TO WRAP i GROUT ❑ 4' ❑ 8' FRAMING INSULATION PRE -ROOF NED' P� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ,DRYWALL INTERIOR . EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK FINALS, / _ I /_ , - ELECTRICAL Lot(7 Illo O PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS ` JOB COMPLETED i r TEMP POWER ABOVE APPROVALDO NOT INCLUDE RIGHT TO pal/95 TURN ON UTILIT S OR OCCUPY BUILDING !j P.O. BOX 1504 APPLICATION ONLY Building �(o (� 78-105 LA QUINTACCALIFORNIA 92253 Address 7 - _ Owner tA j� Mailing T�� BUILDING: TYPE CONST. V W OCC. GRP. s Address A.P. Number City Zip Tel. Legal Description Contractor Project Description Address v Zip .� ., s Tel. State Lic./ &-Classif. �b��D City Lic. # Sq. Ft. Size No. I No. Dw. Stories Units Arch., Engr., Designer New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address m��p� ? 0 - Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY City tY/��1,5 wl1 Zi� y) (�C. S. tate „� y Lic. # �arltS�CVJ1 LICENSED CONTRACTOR'S DECLARATION -I hereby affirm that I am licensed under provisions of Chapter 9 (cgmmencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Side Setback from Property Line , SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031 .5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1-] 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I 1 I, as' owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 17 I am exempt under Sec. B. & P.C. for this reason Estimated Valuation 3 g 3 7 S -00 PERMIT ) AMOUNT ! Plan Chk. Dep. /j�� lC Y 1 g!E), !l Plan Chk. Bal. ORB, Const. 6 ',3 . D Mech. Q(� Electrical 273-271 Plumbing 26.5'J0 S.M.I. Grading Do Driveway Enc. _ Date Owner Infrastructure 600 • Do Sr 4 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner Signature of applicant Date TOTAL) REMARKS Validation: U City, State, Zip t 1 rivu 40 4J lazyJ r'1 NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that 1 have read this application and state that the above information is correct. Issued by: Date F1 Fmwil I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip t 1 rivu 40 4J lazyJ r'1 AAI BUILDING DIVISION Wh CONSTRUCTION ESTIMATE GROUND PLUMBING NO, ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ _ UNITS BONDING HEATING (ROUGH) STORAGE TANK 2ND FL. SO. FT. (li- SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK YARD SPKLR SYSTEM FOUND. REINF. POR. SO. FT. @ METER LOOP MOBILEHOME SVC. OTHER APPJEQUIP. BAR SINK —� GAR. SO. FT. @ / V� POWER OUTLET GROUT ROOF DRAINS SERVICE CAR P. SQ. FT. @ BOND BEAM WATER SYSTEM DRAINAGE PIPING GRADING cu. yd. g plus xg WALL SO. FT. ((? LUMBER GR. FINAL INSP. DRINKING FOUNTAIN FINAL INSP. SO. FT. @ ROOFING URINAL REMARKS: ESTIMATED CONSTRUCTION VALUATION $ VENTILATION WATER PIPING NOTE: Not to be used as property tax valuation FIREPLACE FLOOR DRAIN MECHANICAL FEES WATER SOFTENER GAR. FIREWALL VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) MESH APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED /' LAUNDRYTRAY AIR HANDLING UNIT CFM CERT. OCC. KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC INSPECTOR'S SIGNATURESIINITIALS WATER CLOSET COMPRESSOR HP GARDEN WALL FINAL POLE,TEMIPERM / LAVATORY 2 �- HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c $ATH TUB 2 ^ SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 1& 1'A c � SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac 1-7 Ifo HOUSE SEWER O GAS PIPING 12 PERMIT FEE l PERMIT FEE L PERMIT FEE ^ DBL TOTAL FEES MICRO FEE MECH.FEE PL.CKCONST, FEE ELECT. FEE SMI FEE PLUMB. FEE ��•t2o �T0'`�_�•5 ��3• � 2?3.8i 2b5•S J STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. g plus xg =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 1 " 16 .' DESERT SANDS UNIFIED SCHOOL DISTRICT '' 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date .10/17/95 No. 113769 Type of Permit Owner Name La Quinta golf Properties, Inc. '7R-5&0No. Street Tom Fazio Lane North La Quinta Permit # Log City La Quinta Zip 92253 Study Area 108 APN # 761-521-005 Tract # 128189 Lot # 0 Square Footage 14698 Type of Development I Single Family Residence I No. of units 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 1.72 x 4 698 or $ 8,080.56 have been paid to D.S.U.S.D. for 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 La Quinta Golf Properties, Inc. Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Signature U.—A q nn o Q,e4 A2 ,&k n_N Payment Received " $8,080.56 Check No. 23309 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 Telepioi e 7777=1100 ,z °7. Payment Received " $8,080.56 Check No. 23309 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