9603-088 (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
Prof-assionals Code, and my License is in full force -and effe t`
License # Lic. Class Exp. Dater
Date 7= �� 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
(+%•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.
(`J,,rl,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 whi h,.thjs permit is issued,
I shall not employ any person in�anyma erso as�fo become subject to'the
workers' compensation laws of y� alifornia, and agree that if I should become
subject to the workers' compensation provisions of iection 3700 of the Labor
Code, I shall forthwith comply witf ttios" wpi�visions.
Date:-u�- Cc Applicant 1l 2kt•r
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
r-.a&'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 subje ct.p�errmit to cancellation.
I certify that I have read this application and state that the abov�e,information is
correct. I agree to comply with all City, and Se laws relating to the
State building
construction, and hereby authorize representatives of this /City to en�ir upon
the above-mentioned property for inspection purposes.,// • f rN
Signature_(Owner/Agent)
PERMIT # CONTOL #
R
„.' BUILDING PERMIT
��► � 99
DATE VALUATION. 1 �y yz LOT f �j. TRAC, T ,1 (it;t �Nit
JOB SITE�
ADDRESS 150.390 SPYGLASS au�DRiVE
APN
*%�►`�-� �w1��{�
OWNER
CONTRACTOR / DESIGNER / ENGINEER
V A A'IW X: % LA. QUI -NII: A
rl.Y RS dkOiJl?
507525 GRAND TPLAV EKSE
355 WA
LA. QVIVIA Cts 9215-3
COS'T'A. MRSA CA. 92626
tt1 j% x•55?
.(714�W-61?t,►n C3fA 3,124
'I RANK GONZALES ASSOC.
USE OF PERMIT
SYNC 1; >AAMiL1' :f W Y.1:1NG
IX -46 RAXV CH"MAN AVK
()ANN.W, QA YIftt Q-010-WU
L &QUIWA FA:i:E811JAY111
P1.02V / ..
CUSTOM C, ONS'CRU 'TION AZO KUtr 8F
:PORC, 8/ X"-10 1199 10 SF
GARAOH/CAR.E PWT 484.00 SF
i
PFAMIT ..9 ,MUT (MARY
'PL'AN 01r.C.-K1lEr, 1715.58
Ct;►NVRXIC'!'ION F10: 101-000418-000 stit.(fCt
y
}U143CHAN.(CAI:'t 8% J01-00421-0+3 .5s.10
8 1"sC1'f2TCA1 k7f3F 101:000410-000 35.14'3.6?
PlAW131NOP H D,4K.SU
�Cn3-�4j's�p�(n)fn)
S 1'C3.Ci(t t tt Tit?11'd� tZLti( 1.01 QinA-2
ORAINNOh'Ri��i�iit'�t}-d23-t1b�i � G•tKi
1'N} RAST 1i9 iC f[JHV FTE '225-00044'042 $3,743.481
ART_TN P1.rBUCFLACES-.F1VIRC701.-OW-2551 31713,53
�.
SUS.€DIAL. CONSERUCT1t3N AND PLAN CH1"s4. K
$5,8.9i3;t 3
LA SS PRE-PlUD FEES
$0 00
RECEIPT , ,1
DATTEE� Y AR
BY /
DATE FINALED
INSPECTOR
,v. j
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 Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
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)
COMMENTS:
`..
1 crry OF LA QUINTA
ado, -BUILDING & SAFETY DEPARTMENT °
777-7012
INSPECTION REQUEST LINE
777-7153
ger_ FA 111NVAYS LA 0UIIN'1_A_.__ _
AYRES GROUP mit Number
POST ON JOB IN CONSPICUOUS PLACE
•iSPECTOR MUST SIGN ALL APPLICABLE ,.',PACES
3U=i8QHILL. DRIVE
3 ADDRESS
'I,'D LU'1, 8o PLAN 3K
TYPE Of INSPECTION , _T DATE
INSP.
)NDATION & SETBACK
GH PLUMBING
)TING STEEL
—
N GROUND SYSTEM
I
_ _ _
JUND PLUMBING
_
-GUNITE .
r -
NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CRETE SLAB
STS & GIRDERS
:CTRICAL GROUND WORK _
NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
J_GH ELECTRIC
ERIOR LATH;,
GH PLUMBING
L PRE PLASTER
—
GH GAS & GAS TEST
_
cT
TING 8 VENT A/C
_
:CTRICAL)
EPLACE
AL GAS TEST
-� F
) =
I ll
ND BEAM
TO WRAP
DUT O 4' 8'
-��'rw_—�._.
USE NUMBERS
__–
MING
ULATION
.� ! 'A
l,_.
_.L_'L
-ROOF
COVER
COVER NO WORK UNTIL ABO'V'E HAS VEEN S:GN[L'
'(WALL INTERIOR
ERIOR LATH;,
L PRE PLASTER
—
L FENCE & GATE
YER SEPTIC TANK
FINALS
_
:CTRICAL)
M_BING
AL GAS TEST
_
TING • A/C
USE NUMBERS
COMPLETED
'.11-' POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
()6• TURN ON UTILITIES OR OCCUPY BUILDING
I
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 3/19/96
No. .14287
Owner Name Fairways La Quints
No. 50380 Street Spyglass Hill Dr.
City La Quinta
Tract # 25389-1 Lot # 80
APN # 769-641-010-
Jurisdiction
69-641-010-Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area 125
Square Footage I
Type of Development . Single Family Residence No. of Units 1
Comments
Cirandfathered 2014 sq. ft. Kelly of City of La Quinta said to change last address on work u
heet to above address because of a typo.
At the present time, the Desert Sands Unified'School District does not collect fees ori 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 ,540-6060
Name on the check
.5
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $628.00
' Check No. 2472
Signature
QUfa t n PQ nn� AIJlX),(�,�
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