9603-085 (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, ofethe Business and
Professionals Code, and my License is in full force and effect. '
License # Lic. Class Exp. Date
t+i31b1 i k"
Date %r 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).
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
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 performancedof`th`e 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' compen ationliprovisions. of ection 3700 of the Labor
Code;.l shall fo, wit comply witty tho a rovisro s.
Date:" Applicant C?• �`'� •• —
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'1'80-,days will subject;permit to cancellation.
I certify that I have read tl
correct. I agree to comply
construction, and hereby
the above-mentioned prol
Signature (OwnedAgent)
s application and state that the above information is
with all City, and State laws relating to the building
tuthorize reprk'sentatives of this City to enter upon
Date �--� 9146
BUILDING PERMIT
PERMIT# CONTROL#
%OX0452989
DATE 3i 6n�r! VALUATION LOT
-7'7 TRACT
r
JOB SITE fS p�(s y
ADDRESS ,rJd�••+ 2f) S1`'�*�. LVSV 14ILL li.�K%���.il1
APN
769-64.1407
OWNER
CONTRACTOR/DESIGNER/ENGINEER
VAI KWA.Y1 LA, Qt5fN`1':i
7 Y.rftSGR.QUP
W-525 GItLAND Ik4AVEkSE
;355.1�5RISIX..3I, Ste. Ji A
LA QUINTA CA . 92253
COSTA MFQA CA 92.626
(619;)771.5525 -
(71,0540-&)60 C'81,4 3324
I32ANK (K)NZAi:Ea & ASSOC,
USE OF PERMIT
MNOLP FAVI IA MtLE.,i-W
13-36 EAST CNJAPMAt A,N/i .
�JCCf 04VA!, .Ql rWY4tJ
L A Q'd71NTA FAfRWAYS
PLAN 4
TK_'% .CFI:/PA.Ti0 1f4
OO SP
CrARAGJCARP0RT 513.00
5F
r
ti " it ii D&10 �i1�''r�ONST.i��i�'�' ON
194.19140
PERM T FEF tiIMVkMMY
PLAN CHkf�,"1 VI—T
M5.0?1
i..(�if�`�i`.��LiJ!v�."aiJi�! Its%'• i�a-�I�'3aiis=��i
���i'''�i.f�7'
'
NWC1:iA.NICAL ME' 101 4M-42.1 •tom)
l�:.ir('T'R1t;Alr.1'� -• :k01-()liQ-4211-CR)0
51.35.313
1':1:tJ livC E 1 1�OW-419-.000
1.5.1..519
`i'i 2v'4x N11 -O 'IO23 MC C - R SID 101 -M741 -WO
0, RAL" fi;WF PX t 61-M.42341W
520.00
I4"CCAS i'iiU ;'l`URE fes} 225-000-443-342
SA,3 i 3.c5
All'.1 IPI ATHLIC PL C} SRES1C 70100-2.55-000
.Sa35,4, .
f,11.dk3-"1 OTAL, CON s -MRL its I; ON AND PLAN CHECK
$6,70.01
LESS PRE -PAM FEES
.00±
�'1.*(Y ':A7L iPF.RMrf 1+EWS xDETC NOW
�i,706.01.
RECEIPT
DAT
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
OX 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
OX 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. else of Power
Final
Utility Notice (Perm)
CITY OF LA OUINTA
BUILDING & SAI--&. i'Y DEPAATIVIENT
777-7012
INSPECTION REQUEST LINE
777.7153
w)er FAlRN\/.kYS LA OU1!NIA
ontractor AYRES GROUP
9603=0
'ermit Number _ _ _
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE .SPACES
50-320 SPYGI:,xsS Illl,l: DRIVE
08 ADDRESS
SFD L01'77 PLAN 4
TYPE OF INSPECTION
I DATE i INSP.
OUNDATION 8 SETBACK
R LATH
DOTING STEEL
DOL P
DOL PRE PLASTER
___
-
I
IAIN GROUND SYSTEM
ROUND PLUMBING
?`�-`
RE-GUNITE
0 NOT POUR CONCRETE UNTIL ALL :ABOVE HAS BEE `SIGNED
ONCRETE SLAB ILZ:
�I
DISTS 8 GIRDERS
LECTRICAL GROUND WORK
0 NOT POUR CONCRETE UNTIL ALL ABOVE HAS RF N Sic-i,jFn
OUGH ELECTRIC
RYWALL INTERIOR
_--
R LATH
OUGH PLUMBING
DOL P
DOL PRE PLASTER
___
-
I
OUGH GAS & GAS TEST
�! • ?, c==
?`�-`
EATING 8 VENT - A/C!`
REPLACE
rrr1 `
OND BEAM
—+-`
^
K. TO WRAP'`
ROUT O 4' 0 8'
3AMING
?-
j•� T
ISULATION-
IE-ROOF
COVER NO WORK UNTIL AB VE HAS BEEN SIGNED
RYWALL INTERIOR
r� _
R LATH
'
71
DOL P
DOL PRE PLASTER
___
-
I
DOL FENCE 8 GATE^�
"—--
EWERSEPTICTANK
FINALS
'-ECTRICAL
,.UMBING
NAL GAS GAS TEST --
TING • A/C ----`
USE NUMBERS
)B COMPLETED --
--MP POWER
ABOVE -APPROVALS DO NOT INCLUDE RIGIiT TO "
'96 TURN.ON UTILITIES OR OCCUPY BUILDING
Notice:
Document. Cannot Be Duplicated
Date 3/19/96
No. 14284
Owner Name Fairways La Quinta
No. 50320
Cit, La Quinta
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Street Spyglass Hill Dr.
Tract # 25389-1 Lot # 77
Type of Development Single Family Residence
Comments
irandfathered 2332 sq. tt.
Jurisdiction
zip 92253
APN # 769-641-007
La Quinta
Permit #
Log #
Study Area 125
Square Footage 1
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:
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.
1.�.�: i
this square footage in this proposed project may now be issued. 4 A'� - " �%
Fees Paid By La Quinta Fairways__Telepfi ane t�40-6000
5, ,
Name on the check
By Dolores A. Ballesteros -
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $628.00
Check No. 2472
Signature (�1 , .� Q l aig t1 AX A AQ\ ^Iy✓
v
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