9602-066 (SFD)"i
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. 6 j 3161i 2/28i97
License # Lic. Class f Date
(Date SignatureofContractor
OWNER -BUILDER DECLARATION
I hereby affirm 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 woirKfor which this permit is issued.
O I have and will''meintain workers' compensation insurance, as required by
Section 3700 of the;.L`'abor. Code, for the performance of the work for which this
permit is issued. W..,Workers' compensation insurance carrier & 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 worker --which this permit is issued,
I shall not employ any person in a�anneer o as itcome subject to the
workers' compensation laws of 6alifornia, and agree thaif I should become
subject to the workers' compen s�talion provisio s of Section 3700 of the Labor
Code, I shall forthwith„comply with those provisipns�
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 I- a ,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 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"C' ! and State laws relating to the building
construction, and hereby authorize re�)sentatives of this City to enter upon the
above-mentioned property or•inspeAbopurposes.!
`Signature (Owner/Agent) ` Date
A`°"
BUILDING PERMIT
PERM 'T1,602,111166
DATE !Y
VALUATION #AfRvtcs.x•wt/ LOT +`+ TRACT c; -Y '7..{” ^•ft.�t Its
JOB SITE ADDRESS W260 SPYGLASS �I,llLL �3l�'�it+:
IILL Y
APN 74!"41.004
OWNER
CONTRACTOR
�
Ai`ERS GROUP
FAIRWAYS LA QUMITA
355 8PUS'!TJ1, STAIA
50 -SES GRAND TRAVEit.SE '
C09PA MRSA CA 32624
LA.tt�UINTA. CA. 92253
(714)510-6060 CBI„# 5324
(:re1.9�! PI -4525
DESIGNER/ENGINEER
RANK' !3ONZALP S - ANSUC..
1.:130 EAST Cf i"NfAN PkVL-.
USE OF PERNT,3IN(;'L.J�: FAMILY DWELLING
el VO A. 1.Tn1: f°A O'ffx r•__0j
ftAc73J.ylNTAFAf'CLWAY'S .4 `
h.L AN „l
FEE DESCRIPTION
FEES
CUST011\4 CONS'I'itCJCTJON ?,014.00 SF
PORC11/NAT1.0 138.00 SF
0AR.A.OiJCARP0RT 494.00 5F
%i,ST€ia^INI; UD COST OF CONSTRU
64;212,44)
Pi-,R1Vii`l .1;'.EE St7i�4. MARY
'
:f!t.ANCi_C:Xr-1--F 1ti1-OOG_43*3 31ss 5715.58
L'bN3T1tVC'T13N FM- 101_000-418-4t10 $3$1.00
MOC HANIC'A.I. FIST 10 1-000-421-000
ELECTRICAL l'ml 101-000-420-000 S143,611
t�t,t. l :tf ac? ti=y rs 101-0011-439-000
•A.i+'+.t.t:+vt•'+nJIM t r,.31D 1{� 9 �{ n 2Ri MV
!V !'�`-i'..[:.1.t4� A{Il WVV•!.Y!-�V-
C'lRAI:r NO FEB, 101-(hi(I-423-OGfi
1:w12A.r:Ctw- 225-100.4+83-312 S3.7'd” AS
Af?T !N 1'UAl.:,IC P1,AC 33 FM (D 701.-000-255.M, 0
N
SUB-TCMAL CONSTR:UCUON AND P1.t N CHECK
$5,890,08
LESS PREPAID FPS
4
$0.00
08
MAR 081996
t.
ey
RECEIPT' ••
.D T�
BV
DATE FINALEO
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —
Underground Ducts
Forms & FootingsDucts
I
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap —
F.A.U.
Framing
Compressor
Insulation - of
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
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final 1 4,6 —
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 —y
.Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
-Date 3/4/96 APN # 769-641-004
No. 14197 Jurisdiction La Quinta
Owner Name Fairways. La Quints Permit #
No. 50260 Street Spyglass Hill Dr. Log #
City La Quinta Zip 92253 Study Area 125
Tract # 25389-1 Lot # 74 Square Footage 1
Type of Development Single Family Residence No. of Units 1
Comments
Grandtathered 2014 sq ft
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: '
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Mitigation Agreement
in the amount of 628.00 X 1 or $ 628.00
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 Fairways Telephone 714-540-6060
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
� ` 4
Payment Received $628.00
Check No. 02356
Signature
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