9512-065 (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
7v�34t0 B 3/31197
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�i4ssug{vlyyworJke.Mepmpensation insurance car%ii9ry;&„(policy no. are:
Carrier - Policy No.
(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 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 applicaton agrees to, & shall, indemnify
& hold harmless the City'of La Quinta,jits 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.
Signature (Owner/Agent) Date
PERMITt
CONTROLk6UILDING PERMIT
•►�2942
DATEVALUATION LOT TRACT
lX .
t1/96S419,840,.20 43 72JOB
SITE
ADDRESS 79-60 TOM FA7J,0 N.
TPN'761-522-020
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Mfit!l f, 4% SEDON1'l NIDE LEA
T1JRPIN COMM'RtJi:MON CO.
73477 tiouf'.tt.1M UR
54936 SHOAL CREEK
PAIN DVSFRT Ci4 92260
LA QU1N7 A CA 92,1_53
(6191777-761.1 C}3 11 3751
USE OF PERMIT
SINCi1,t. PjAMiLY [aWki.,,iN0
s
MS'1'OM CONS'i`RUC 11.c.N 5;1511.00 w.
(fARA(WC'11iti't W,11' 9211.00 alp
1".S17Aii'1; D COST OPCONSTRUCTION CTION
419.840,20
3'1✓RMI li`I>rE SUMMARY
PLANCi11:C;IC I-Tti? 101-000.439-3111 'i`l.Si9.t2
A4c'4.HA1d1CAL FFE JOIM042.1 }00 $226.50
IBUL<, ER(CAL 111X 101-000-420-000 a315.83
PLUNIRIN i.FEE 1ti1•�1��!)-�l•l*J-iN)t) 5.;51..75.
STONO N40't'dt:AAI FM - RrSlt) .104 -00.0 -241 -WO $44.30
QP,AY)IN i 1fi�: l:t?1. 0ilt?.�I23.Ot30 $20.00
I14PRA,5r11UC:.rIII W FU.' . 22570(W -4433-3W2 Sti,(i:3i�.e►fi
f=f 3i lil;k't3 311' 42511.00
t;t:41J;�7'1tC7C".Plf)'Pl r1w 101.006-4181000 91.751.50
AP,1' 1N hUfi3LIC R AS:`La - RES11; 701.1300-255-01M $"1%9,60
r
SLIP,'"11 . CONSI`RUM(. N AND PLAN CfIECK
$t
LESS M&PAI13 WhS
-$250.00
TOTAC,1'h.RMIT 1, iN.ES 01113C NOW
S10,906.60 '
RECEIPT
DATE
BYD
FIN LE
INSPECTO
f—
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
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
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
COMMENTS:
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)
Notice:
Document Cannot Be Duplicated
Date 3/11/96
No. ' 14218
Owner Name John Miller
No. 79615
City La Quinta
Tract # 4327728
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Street .Tom Fazio North
Lot # 43
Type of Development Single Family Residence
Comments
By
APN # 761-522-020
Jurisdiction La Quinta
Permit #
zip 92253
Log #
Study Area 108
Square Footage 5455 � � d� . 4.
No. of Units 1
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 4
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 x 5,455 or $ 9,382.60
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.
,rte
Fees Paid By Turpin Construction �._ Telephone 777`7611
Name on the check'01 k�
Y a.,
Dolores A. Ballesteros
Superintendent j <,�
Fee collected /exempted by Pauline Pearson Payment Received $9,382.60
Signature ,;, . P -1a, A\k.' 1 XI ,/Y`
Check No. 0431
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
L K. B. LEUNG AND ASSOCIATES, INC.
STRUCTURAL ENGINEERS
9320 BASELINE, SUITE D
RANCHO CUCAMONGA, CA 91730
(909) 944-0029 FAX 944-7983
August 21, 1996
Attn: City of La Quinta
Re: The Quarry at La Quinta
Lot 43
To Whom it May Concern:
This letter is to inform the City that K. B. Leung, as engineer of record has reviewed the roof
truss design and layouts, dated 6/6/96, as prepared and designed by "Spates Fabrica-
tors". We find them to be acceptable and in general conformance to the structural plans.
Thank you for your assistance.
�ar Ban Leng, President
K.B. LEUNGAND ASSOCIATES, INC.
KBL/Isc