9603-087 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9.(commencing with Section 7000) ofDivisioo 3 of the Business and
Professionals Code; and my License is in full force and ffe • .
License # Lic. Cla4 Exp. Date
v1.31u1 }� � 'if:t�il�1
Date,3�� Signature of Contractor
v
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).
O 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
perforrpance 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 I Policy No.
(This section need not be completed if the permit valuation is for, $100;60 or,less).
�.0 V�
O 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�lthat if I should become
subject to the workers' compen ation provisions o Sect_ tion„3700 of the Labor
jCoden shallforthyvjth comply wit tho'e•<• rsIr
• Date: � � (a 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, 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 tli s 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 insj cticn purposes. .
\?Signature (Owner/Agent)
�...•.' BUILDING.PERMIT PERM'S : CONTROL#
2 991
DATE VALUATION I:di4.:1! 2��d10 LOT ��� :TRA
AC0 1'Iifi.*, IV
JOB SITE ADDRESS 5%360 SP (si.lt,M 10LL 1)Kivit:
APN 769-64.40
OWNER
CONTRACTOR
/p/DESIGNNEER / ENGINEER
n fUS r j j ((�
?AJ.R.V AYn,Q i,r A—"I6,AN1..9� �
y
A i i:. FTS .ill ia�i,J'1�
30, S2 5 Cr1LA �i Cf 'i"lav t\ l�tsR�+E
153 BIDS .l 01, S7. YA
1.A Q1:.11:nl rA C.A. 912253
C_0STA MES3A CA 92
(("119)7' 1-5575,
CD 3371.
FR&WK GONZA F,S &SWC
USE OF PERMIT
SiNGLE VAMALY I. AWRL1ANG
IXW� k&KJ' CW: PMAN AVE,
. - _ J Vd.tYw v.Gt2VC1 �i (d Wit
LA Qt.f1' ITA, F.Al'iMAY S
E'`C!S',ixw CONST-kiJ gIoN- 2,014,00 SF
POP, 41PA.'1 0 138.U1} St~
0,ARAIG1 JCA:RPOR'r 1.'; t.!?f1 SP
LSTI A'f ai,�i) COSTi3F CONSTRvCT:iON
109,21.L40 .
PEAZy1 T ,1f`it,E SUMAIAR
k':LM CHECK 101-00(. �}201 .3.18 371558
C014111111RUC171014 FE61 101-000418-000 SM1.00
40', ,4AI.11 AL.FMI, 101.000-•42:1-000 353.50
€iL Isc. TRICA1', ItE 1.01-1100.420-000 5143.37
:�i f.IR 31NC. l� N:1i 40t il[i0- '13>-900 3105.10
UNG MOTION FEB : RI:SID 101---000-241-000.. - SKIM
GfOLANO AE F l01-WO-4.23AW $210,00
1C+,1F8.f4,S9'1UFC"!'UH r FEL 7.:25-000-443-342 $3.7431
mtT IN Nl SSI is PLACE � # 1:011; 701 �Jt�0-235.000...
SUB-`l't7rAl. MIS`l'.1•LLJC' ION AND :PLAN CREC.t:.
$5.V0,08
LESS '.PRE -PAW FEES
$0.0
t;
TUB e1,..1i~IEit1!"i'i' 11f 'E1L NOW
RECEIPT ..� �
DA�E, ��''f / y �.�
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 Wail 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
Wity Notice (Perm)
-
} CIT OF LA QUINTA
SUfLDIN,, l; sAF=ETY DEPARTMENT
777 -?012
INSOEC:TiON REQUEST LAE
777-7153
Owner _ A l R W,gk N` L ik • D I NaA_T
Contractor
Permit Number ___
POST ON JOEL N CONSPICUOUS�PLACE
INSPECTOR MIDST SIGN ALL APPLICABLE SPACES
if'V(;L..1S 1.1ILL. DRI VI:
JOB ADDRESS
SFD. o•r 79 1"I'AN 3
TYPE OF INSPECTION
DATE
INSP.
FOUNDATION & SETBACK
- U % -`
JOISTS 8 GIRDERS
FOOTING STEEL
ELECTRICAL GROUND WORK r�
MAIN GROUND SYSTEM_ '
r
GROUND PLUMBING
-
ROUGH ELE� TRIC
�,_._�_.-
PRE-GUNITE
ROUGH GAS &GAS TEST
vv "IV i rVun L.UNGHLTL UNTIL ALL ABOVE HAS BEEN SIGNED i
CONCRETE SLAB
-�-
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK r�
,ADO NOT P_0_UR_CONCRETE UNTIL
-
ALL A13OV_E HAS BEEN SIGNED
-
ROUGH ELE� TRIC
�,_._�_.-
ROUGH PLUMBING • _._ , _........_r_-_,'__�y._
_
ROUGH GAS &GAS TEST
HEATING & VENT
FIREPLACE
ROOF
BON
O.K. TO W"A P'`
-
GROUT �12 a' 1D a,'
FRAMING ._..___._.._.__.�___....._-..
_-
-,,•-; ,:�.-
INSULATION
PRE -ROOF„ ��•� }-
''- ..
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR •___~�'?�
4:...w_
'�.t'
EXTERIOR LATN--a....----.
: __C,,
.
POOL PRE F'LXS�
-
' POOL FENCE & GATE
SEWER SEPTIC TANK
. r'-'-�
----
-•----.__...- FINALS
ELECTRICAL
PLUMBING _-�
FINAL GAS IETF
HEATING
HOUSE NUMBERS
JOB-Ct7MPLETEU----���`_.�_.__
i
TEMP POWER.
4 -;OV[ APprTL')VAL5 DO NOT INCLUDE RIGHT TO -
1196 TURry ON ;,TIL!;'1 OR OCCUPY BUILDING
Notice:
Document Cannot Be Duplicated
Date 3/19/96
No. 14286
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN #
Jurisdiction La Quinta
Owner Name Fairways La Quinta
t. No. 50360 Street Spyglass Hill Dr.
Cit, La Quinta zip 92253
769-641-009
Permit #
Log #
Study Area 125
Tract # 25389-1 Lot # 79 Square Footage 1
Type of Development Single Family Residence No. of Units _1
Comments
grandfathered 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 B 'Fele i one �
By La Quinta Fairways ' �;.�; .7 p 540-6060
Name on the check;,
By Dolores A. Ballesteros
Superintendent I� -
Fee collected /exempted by Pauline Pearson Payment Received $628.00
Check No. 2472
Signature ,y �'t10 l" l ,C'lt ,t;q_Cly`
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