9603-086 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cl_�pter 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
til.�it11 a e40'24?41
`Date - ? Signature of Contractors
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&RC. 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.
( t)„ 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).
O I certify that in the performanp a of-the.work for which this permit is issued,
I shall not employ any person idany manner so a to become subject to the
workers' compensation laws of balifornia, and agree that if I should become
subject to the workers' compenstion provisions o Section 3700 of the Labor
Code, I shall forthwith comply wit th6's_e,provisions. -��
Date: = e Applicant Y
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 inspection pulPoses.
Signature (Owner/Agent) Date J
BUILDING PERMIT�J�3�o
PERMIT # CONTROL #
2990
DATE �� ( r�� VALUATION �1�9�i��1 �� LOTS
TRACE Ma) q kgt
JOB
ADDRESS 51-k .E' 0 `��° rl.<;Sk 1ARLL.��MV21,
APN
127�t�fS �WY
OWNER
CONTRACTOR/DESIGNER/ENGINEER
} S'2j6rRAN I KSI'.
LA QIANNTA t- A 0P5A
('0,1 A NIE-1 A CA 9,10 N
.f"kANq,� �C.AVe"fiU.:i ASS%dl.'.
USE OF PERMIT
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I AX, FANT(4tAPNWAVE,
I- "JINTA,1aAIRWAYS
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Il;',7TIM, V1U11 411:T M E% DUV NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
y r y
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 PI . 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
Utllity Notice (Perm)
k6l
CITY OF LA QUINTA
Of BUILDING & SAFETY DEPARTMENT
777-7011
INSPECTION ; COI -;I -:ST LIN
777-7153
vnef FAIRWAYS LA_ UINTA o
�ntractor AYRES GIZOUP
�rmit Number
POST ON JOB IN CONSPICUOUS PLACE
NSPECTOR MUST SIGN ALL APPLICABLE SPACES
50-340 SPYGLASS HILL DRIVE
)B ADDRESS
SFD LOT 78 PLAN 3R
TYPE OF INSPECTION OA 'M I INSP.
IUNDATION & SETBACK
TOTING STEEL Y A) �
SIN GROUND SYSTEM
IOUND PLUMBING (7
iE-GUNITE
) NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
)NCRETE SLAB
FISTS & GIRDERS
ECTRICAL GROUND WORK —
NOT POUR CONCRETE UNTIL AL_L ABG_VE HAS BEEN SIGNED
)UCH ELECTRIC
:)UGH PLUMBING
FINALS
_
)UGH GAS & GAS TEST
�l-
:ATING 8 VENT - A!C
,UMBING
4EPLACE
NAL GAS TEST
)OF
) N D BEAM-+-�--�
)USE NUMBERS
K TO WRAP
, 7 r
a7,=7
TOUT 0 4' ❑ 8'
-MP POWER
LAMING
SULATION
T
tE-ROOF.
X96 TURN ON UTILITIES OR OCCUPY BUILDING
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED_
4YWALL INTERIOR
(TERIOR LATH
)OL PRE PLASTER
)OL FENCE & GATE
SEPTIC TANK
FINALS
,ECTRICAL--!–
,UMBING
- - _-
NAL GAS TEST
)USE NUMBERS
---
)B COMPLETED
-MP POWER
----}---_�..--�—
ABOVE APPROVALS
DO NOT iIvCLUDE RIGHT TO
X96 TURN ON UTILITIES OR OCCUPY BUILDING
Notice:
Document Cannot Be Duplicated"
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 3/19/96 APN # 769-641-008
No. 14285 Jurisdiction La Quinta
Owner Name Fairways La Quinta Permit #
No. 50340 Street Spyglass Hill Dr. Log #
City La Quinta Zip 92253 Study Area 125
Tract # 25389-1 Lot # 78 Square Footage 1
Type of Development Single Family Residence No. of Units 1
Comments
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.
.,f✓� Ifs wc„. y �� .
Fees Paid BY La Q y= T le none
Quinta Fairways � =540=6C-60
Name on the check .�, ;w r
By Dolores A. Ballesteros'.,'`
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $628.00
Check No. 2472
Signature Q_ 7 \ 0O na n A A,�w`
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
4
N
_GFa_n_UFa_ffie_reU
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.
.,f✓� Ifs wc„. y �� .
Fees Paid BY La Q y= T le none
Quinta Fairways � =540=6C-60
Name on the check .�, ;w r
By Dolores A. Ballesteros'.,'`
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $628.00
Check No. 2472
Signature Q_ 7 \ 0O na n A A,�w`
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