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9602-069 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and'-ProfessiorQs Code, and my License is in full force and effect. ).�... . cii'I16. er .hl`rIt Licens_ Lic. Class 1 Exp. Diata _ <,Date ""' Signatureof Contractor C OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following reason: K ( ) 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 Data Signature of Owner WORKER'S COMPENSATION DECLARATION' Irhereby affirm under penalty of perjury one of the following declarations: () 1 have and will maintain a. certificate of consent to seN-insure for workers' compensation, as provided fogy 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 thework 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 aslto ome subject to the workers' compensation laws of Caglifor a -and agrthat if II should become subject to the workers' compens /'on provisions of Sect�3700 of the Labor Code, I he o w comply with " se provisions. r' Date:"' 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 resulV&ithis application agrees to, & shall, indemnify & hold harmless the City of Indiam.Wells-Its officers, agents and employees. 2. Any permit issued as a resuli 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. r 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 repr sentatives of this City to enter upon the above-mentioned property, for inspection purposes X01 / 'Signature (Owner/Agent) Date A`°' BUILDING PERMIT F6ViMlTs� uy DATEV ty/eft VALUATION i�+�� .� Z r LOT I TRACT JOB SITE ADDRESS 11M.1, DRIVE APN 16. -641412 •0' OWNER t CONTRACTOR i .ri ArinURN'Ti� • llel 103'1,s' I - 6"i• 4.AI"-1f!A ! .l.J✓IJS4, I.y 4\.I 1.i f.11: /fl, - (;.525 ca!U-010'rkAVLMSIE d:;(ia.lA MESA CA 92626 L A. QU1 NTA. CA +3.22 53 ;, t (-714)540-6060 f" 131,# - 3324 ;DESIGNERIENGINEER -- (fi i. i 17RANK 00MA1 ES ,ABSOC, 1336 EAST C".1MAPMAN.AVE. USE OF PERMIT; INCj LE 1;AIv111�Y.DW1s'd,.l;'1Z O '•'.AV'tit'•\J �:�:• _ .. _ :y Vf'i• mow. v-Vf LA Qt)tNTA #�.AARWAYS PLAN 3 I FEE DESCRIPTION FEES Q0,8.COM C(),?J8'1 KlJi TI0N :'2,014.00 SF PORCH/PATIO . .: 138.00 SF ' CitARAG&CARPORT 484.00 SF i 1±�5'B'13l9tsTE D 4'i)ST 6F twY.iNSB'R UCT11 1-4 1611411-40 PE, RMIT FEE SUMINIARY t�s:ltt�rrl�:ct::Ft�'R 101-OOi4-�1.'�9-�1f� S'�1.,a3 ' Co;Pi',,3rliuC4'.[Cisdt;J 101000-�l1f30f}ti $t1B1.(Id MECI:IANICAL MCI I 101 -C -00421 -OW 553.50 EI:Ir 3MRICALFELE 101-M-420.00 $1431 .67 : l7A.C714C6iCL�1�11%iii 1Qi�Qi}A-�].i53-QSTf; f;.ld5,R0 4TONG MOTION Z - RESW 101-000-2.41-600 $16..82 ORAL1ING #%hV, ' 101-000-423-000 920.00 IN. F.RASTIZUC TURF FEE . 225-000-443-342 53.743.48 ARS' !N PUBLIC PLACES - RESP 701-000-255-M SUB-I'OT , COMSMUG"i'ION AND PLAN' CHECK LESS PRE -PAID PEES $0.00 -At PC, RAW FRE S DUE NOW N 0B1996. ey RECEIPT DATE / 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 _ Q Exhaust Fans O.K to Wrap F.A.U. Framing — ffit 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 — --3 Final Final iii�jPOOLS BLOCKWALL APPROVALS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 S_w4r Lateral Pool Cover Connection Encapsulation s 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 r Utility Not" (Perm) COMMENTS: Notice: Document Cannot Be Duplicated Date 3/4/96 No. 14200 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE APN # 769-641-012 Jurisdiction La Quinta Owner Name Fairways La Quinta Permit # No. 50420 Street Spyglass Hill Dr. City, La Quinta zip 92253 Tract # 25389-1 Type of Development Comments Log # Study Area 125 Lot # 82 Square Footage 1 Single Family Residence No. of units 1 sq. 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 By La Quinta Fairways . Telephone 714-540-6060 Name on the check By Dolores A. Ballesteros Superintendent, Fee collected /exempted by Pauline Pearson Payment, Received $628.00 Check No. 02356 Signature �� QyM� P1, QAiA4 A_ 0 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 CITY OF LA OUIN•'I'A BUILDING & SAFETY DEPAFT[MEN1 777-7012 INSPECTION REQUEST" LINE 777-7153 AN"RE'S CROUP 9602-U69 --_.-______-•----.__-. _ ON JOB IN CONSPICUOUS PLACE )R MUST SIGN ALL APPLICABLE SPACES 5S 50-420 S1`13CLASS HILL DION/F LOT 82 PLAN 3 iF INSPECTION DATE INSP. I 8 SETBACK —'— STH�rt�--- -ASTER C L� SYSTEM_ JM©ING 'IC TANK, — JR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED LAB DERS GROUND WORK' I I dR CONCRETE UNTIL ALL ABOVE HAS BEEN 5IGNED ;TRIC— AX TNG -- 8 GAS TEST _NT A/C D 8' I NO WORK UNTIL ABOVE HAS BE' -:N SIGNED — ITERIOR -C —'— STH�rt�--- -ASTER C 8 GATE 'IC TANK, — FINALS DVE APPROVALS DO NOT INCLUDE NIGH f TU rURN�ON UTILITIES OR OCCUPY BUILDING EST i —'— C -- — — BE'RS — DVE APPROVALS DO NOT INCLUDE NIGH f TU rURN�ON UTILITIES OR OCCUPY BUILDING