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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
Dated 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 issued. My 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 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 o� California, and a rle that if I should become
subject to the workers' compensation provisions of S ction 3700 of the Labor
Code, I shall forthwith comply wik thgse provisions. _ .'
Date: F' Applicant %-A-
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
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 inspection4 purposes.
Date
Signature (Owner/Agent) " �`' P �r✓6
PERMIT # CONTROL #
BUILDING PERMIT
DATE �VALUATION F� Q tea.,fi�) LOT 84� TRACE?988
,
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JOB SITE) D1111 -1111
ADDRESS di; l SpI i LAl ,"14 IHI,I, D�g
11 -1111
APN e t
AMY QD' s`� Mail
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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USE OF PERMIT
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RECEIPT
�
DATE pp
By
DATE FINALED
INSPECTOR
'In�. n r e � Y
INSPECTION RECORD
OPERATION
DATE I
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 Wali 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 PI . 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
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: -se of Power
Final
Utility Notice (Perm)
c�
4 CITY OF 1_A QUINTA
.• Sys`
BUILDING & SAFETY DEPAR T TENT
777-7012
INSPECTION REQUEST LINE
777-7153
FAIRWAYS LA QUINTik
ctor
Al'IlI?S (.�ItUl11'
Number —
)OST ON JOB IN CONSPICUOUS PLACE
'ECTOR MUST SIGN ALL APPLICABLE SPACES_
50-300 SPYGLASS HILL DRIVE
DDRESS
1-01" 76 PL.NN 4R
F...___.--...
TYPE OF INSPECTION
ATION & SETBACK
0F,TE ;NSP
t%
IG STEEL
IOR LATH1-'-�-
'RE PLASTER
ROUND SYSTEM
•ID PLUMBING
i ITE
-L — -
,T POUR CONCRETE UNTIL ALL L ABOVE HAS BEEN SIGNED
?ETE SLAB
C- �', l;- ..
_
& GIRDERS
_
--
RICAL GROUND WORK
POUR CONCRETE UNTIL ALL A_ BOVE H_A_S BEEN SIGNED
I ELECTRIC
i PLUMBING
i GAS & GAS TEST
IG & VENT - A/C
--� —
ACE
I
_BEAM
D WRAP
_
O 4' O 8'
qG
TION>""--
OOF
:'OVER NO WORK UNTIL ABOVE HA;•: SEEN SIGNEC
ALL INTERIOR
/ ,'.E`
LING
3AS TEST
IOR LATH1-'-�-
'RE PLASTER
IG - A/C
-ENCE & GATE—
)MPLETED_
--,-
I SEPTIC TANK
POWER
I
FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY GUILDING
LING
3AS TEST
IG - A/C
NUMBERS
)MPLETED_
--,-
---�—�------ -- -
POWER
I
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY GUILDING
Notice:
Document Cannot Be Duplicated
Date 3/19/96
No 14283
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Jurisdiction
Owner Name Fairways La Quinta
_ No. 50300 Street Spyglass Hill Dr.
City La Quinta I r zip 92253
Tract # 25389-1
Lot # 76
APN # 769-641-006
La Quinta
a
Permit #
Log #
Study Area 125
Square Footage I
Type of Development Single Family Residence No. of Units 1
Comments
Grandfathered 233sq. 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 Occ\yupancy for
this square footage in this proposed project may now be issued.` w U;
fJ
Y La Quinta Fairways ,, * :.Telep� ne
Fees Paid B - 40-60.60
Name on the check
By Dolores A. Ballesteros Y ' r� _ �C.
Superintendent 141E if
Fee collected /exempted by Pauline Pearson Payment Received $628.00
Signature P,
Check No. 2472
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