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9602-072 (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 Professionals Code, and my License is in full force and effect. 6.13161 2/2$197 License # Lic. Class Exp. ate Date �..0 SignatureofContractor OWNER -BUILDER DECLARATION I hereby affirm 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). ( )" t 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). ( ) 16ertify 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 Cpifo ra'nd * agree that if 11should become subject to the workers' compens on provisions ofaction 3700 of the Labor Code, I shall forthwith comply with tho a provisions. -N `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 resuftfoflthlsrapplication agrees to, & shall, indemnify & hold harmless the City of Indian Wells, its 6 ficers, 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 thiisapplicatior;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 representativesAof this City to enter upon the above-mentioned propert `for inspectlJn purposes. r � Signature (Owner/Agent)) _ ter Dated ALCM PERMIT -==PERM PERM'TIU02-U.'.2 �.BU.I�DING p DATE 3, 096 VALUATIONwierwer,r+.w.`r•vvr LOT ayy TRACT JOB SITE ADDRESS 79,835 SPYGLASSHILL DRIV APN 769441-019 OWNER CONTRACTOR AYF;R.S GROUP FAIRWAYS LA. t7U1i rA 355BM`i OL Si', #A 30-325 GRAND TRAVERSE COSM MESA. CA 92626 I.A.O(ANTA CA 92253 (714)5il!)-ciQbO CBL# 1324 DESIGNER/ENGINEERr��,�'�� w PSS' � . tir 'fes 1'Y\. /lel .' f* f!\ I:K% FAST CH"MAN AVE. USE OF PER`"v,eaw ,. , �...:. ,.. ,..,, ,,. C7RANUE, CA 92666 C:-016340 LA QU.INTA F AI -R WAYS PLAN "3 FEE DESCRIPTION FEES C 0.VI't:ih,l t.;'ONS'1'12UCTTON 2,014.00 SF P0RC1 MATY© 1380) SF GARAIGOCARPPORT 454.00 SI: UST IMAT ED CAST 6.F CONSTRUCTION 168,211.4() .PURMIT IFEE SUMMARY I� . N, AN C-14ECI<. FEE, !Ir11 �tryi(�)-439-'3!R V115.5811110 IS�)'17UCII.10?� FIX 101^000-418.000 �f4t.i0 MECHANICAL iZE9 IOt-000-4211-000 $53.50 ELECIMIC:AL FIRE 10:1-000-420-000 S143-61 PLIWRIN£1 _F"ice 1014)()0-41.9-0(12) S145.50 61'2 N i NIOT1O'tl F,Lfz, - ti13810 101-000-2411.-000 Sif.82 isi`IFRAS'1'12.1JC'i[IM2 Ff* .225-000443-342 ART TN PlfRIAC PL f1,CH44 — RUSfT: 70:1 ^000 -25i -M SUS -TMA., CONSTRU(Trl(JN AISM PLAN CHECK .. $5,890.08 LESS PILE-PAI.G FEES $0.00 'L►�' L I ERINI1T'.FEES DUE NOW S5.8 J tl.08 MAR p g 1996 I i By RECEIPT DATE--- _! By DATE FINALED INSPECTOR INSPECTION RECORD e 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 Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APFf ROVALS 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 U plity Notice (Perm) ^ C CITY OF LA QUINnA ' �• BUILDING S SAFE -7Y DEPARTMENT 777-7012 INSPECTION REQUEST LINE= 777.7153 )r FAIRWAYS 1..A QUINTA actor�lYR Is (;ROUP 1602-072 - ----- ---- it Number POST ON JOB IN CONSPICUOUS PLACE ;PECTOR MUST SIGN ALL APPLICABLE SPACES ADDRESS-- 78-835 SPYGLASS fIIL1, DRIVEi LOT 89 PLAN 3 TYPE OF INSPECTION DATE - � I INSP. IDATION 6 SETBACK -� ---- --- ING STEEL G / �.• ^ - GROUND SYSTEMF�_� I NU PLUMBING GUNITE -��._. OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED RETE SLAB 'S &GIRDERS TRICAL GROUND WORK _ 1 T POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED 'I I ELECTRIC ei "-� GAS TEST`- ➢H PLUMBING ING - A/C -- ---- --- ;H GAS 8 GAS TEST %-� �.• ^ - ING 8 VENT - A/C 'LACE ._------- -��._. BEAM � i •�. ,C.d_. r �__.__ ..- _ .. •. � ,c�`x%,,,_ I'0 WRAP JT ❑ 4' ❑ 8' ING .ATION ROOF COVER NO WORK UNTIL ABOVEHAS E;E�N SIGNED - vWE INTERIOR RIOR LATH -- PRE PLASTER FENCE 8 GATE— :R SEPTIC TANK FINALS TRICAL ISING ei "-� GAS TEST`- ING - A/C -- ---- --- >E NUMBERS -4-- 'OMPLETED POWER — ABOVE APPROVALS DO NOT INCLUDE RIGHT 1'0 TURN ON U...TILITIES OR OCCUPY BUILDING Desert Sands Unified School District Notice: 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE • Date 3/4/96 1APN it 769--641-019 No. 14203 Jurisdiction ' La Quinta • Owner Name Fairways La Quinta Permit # No. 78835 Street "Spyglass Hills Dr. City La Quinta zip 92253 Tract # 25389-1. Lot # 89 Type of Development Single Family Residence Comments Grandtathered 2014 sq. ft. 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 this square footage in this proposed project may now be issued. , Fees Paid By La Quinta Fairways Telephone' -714m5,40-6060 Name on the check By Dolores A. Ballesteros - Superintendent i f• Fee collected /exempted by Pauline Pearson Payment Received $628.00 Check No. ' 02356 Signature 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