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9602-071 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm, that I am licensed under provisions of Chapter 99 (commencing with Section 7000) of Division 3 of the Business Vid'ProfesMonalss Code, and my License is inull force and effect. n1 { Li, iEi:tbl`11 Licers»'•#'. `� Lic.C�ls f\ Date EateC Signatureof Contractor—.: OWNER -BUILDER DECLARATION I hereby affirm that I arh 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 I hereby affirm under penalty of perjury one of the following declarations: () J 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 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 California -,,and ar"'that ifI should become subject to the workers' compens on provisions of Section 3700 of the Labor Code, I shall forthwith comply wi those provisio 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 result of thi's applicatiop agrees to,-& shall, indemnify & hold harmless the City of.Indian VUe`II's?lts,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 comp) with;all City r�d State laws relating to the building construction, and hereby uthonze re resentatives�f this City to enter upon the above-mentioned props for Insp4tio purposed r� Signature (Owner/Agent) I Date ALC " BUILDING PERIVIIT PERMIT9607,071 DATE 3/ 4196 VALUATION'S���������� LOT � TRACT 25389:-1 PHASE lj1 JOB SITE ADDRESS APN 7i+i ,Sr V (;LA3.S HILL DRNT OWNER CONTRACTOR AE'RSGROUP . 117 \Y_A'S e/ J , pL A'SM % A 3151103DRXMOL STP.. 30-525 GkMD AAVIRS.E 'CCJS'i'i# MESA CA 926.26 LA tZUINTA. CA 922.53 (7JA)54"(X0 3124 DESIGNER/ENGINEER ('019)771-5525 ` 1;1 Mr. GON.ZA(:CS ASSOC. 1336 EAS, T AVE,.. USE OF PERMIT . a1NQ,13 FAMILY 13WE1,L1149 vacrarvvxs, d,.ra �t..oae s,;,vra.wv 1..A. QtY1 V':t'A r A RW AY S int=AN 3 FEE DESCRIPTION FEES CIJISTOari. CONSTRUCTION 2,014.00 PORCIJ/PATIO 1;1ff,(i{l SP 4JAR.A0E/CARJP10f'r 484.00 19 f CIS1111,11tWIF D C10sr 0I1' C6TrNSfRVC,i'8ON ;> ERNITY FEESUMMARY 101-000-419-318 $713.58 CON'1kcIJt�1:'!'��AT.0 l3 10i-000-418.000 m.I.fiU N.iIX I,ANIC;AL I i'As ltJt ti 1-�IEl.-Ui6i) 55 . 7 19XCr"f. W1C" AL 1 1 N 101400.470-000 70-000 $143.67 1'1.1:tR�13(;1�±L� 1 sS 10J-000-$29-600 $145_140 - c.r• ' ', ,f0 0 1i. Y7 1 '• PY6t1�M r�1.iiVV.aoiV',}�iV!1'�l6'.ISs: �,�iGIJd �.V t'i1uU—c 1VVV© :g4V.0&; C4t2,ADING FREZ 101_00042X" $:ttl.tlii x.NFRAS'.TRi,IMWE FEE '21,27 5 00D -41? -342 $i,74`148 ARIr 1N e t)E,� At3 P1 A.C,aw - rtJ > r); 71)x -s1 )-SSS tk'j0 �1.7rao.S SurvimAL c0N;srR:JcnoN E4vNm PLAN C14EC-; �s;S9a.o�3 a LESS PRE -PAID .%Ela $0.00 1 MAR 0 8. .1996 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Back -b Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans 0. 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. 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 Seaver 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. x Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: CITY OF LA QUINTA t31_ilL.!�'N(; c S A" E Tv 01='-ARI'M ENT 777.7012 INSPEC I. ON �IEQIJES'f' LINE 777.7153 D,Yner __... -...FA I It11' A Ys L. 0 l ' I .N Contractor R ES (,'RO 1) Permit Number_..._..--_--.__..._ ...._...___._...._._ POST ON JOB IN CONSPICUOUS PLACE ItJSPEC;1.OR'v?U'>1 '�'�a'i'I :�i.'_ A,f�1'I Ir:F\C�I.E' SI�ACES "_� -=-- -- ?C.:i�a: �1'Y(;I.,�•ti� Illl:l. UItIVI�� 5Ii I) L,0 1' 88 PI..AN 3 TYPE OFINSFL'f;il(.)h; DAI'L INSP FiJUNDATIUN 2 SETBACI,.._._.. .. ,. .... .....--•- -. K FOUTIN'U 81'EEL __..._..__....---..____._... __._...... •' is ::. _ .... _,.._. GROUND P'_Ufrt[j:;,t? 7, f'FtE•GUNI t M� . DO NOT POUT, CONCRETE: UNTIL ALL ABOVE: 14AS BEEN SIGNED CUNCRE'fE S,E3 .A—�. ._ JOISTS & GIRDERS I EL[CTRICALGRO'UNIOV-OR;C_.. DU NOT" POUR CCNCIL<<'tE UN t'IL ALL ADO` E HAS UE EN SIGNED ROUGH ELEc;TrIC ; �' ROUGH PL_L!fvIBINC; _-•--_..-+.., f .,'�. ROUGH GAS & GAES S TT -��.,-;— -'rte _ HEATING d VENT a„ -C FINALS FIREPLAGE f:. :301`ID 4SL"r1i ..... .. . ,........-..A..f;_ _..___..__._...___.........--_.. / - f=�- _-.1•_.- GROUT 2 a' a' HOUSENUMBERS iINSULATION PRE -ROOF - COVER NO WORK UN'I:A©GSC ,F{Aj?t FN SIGNEU D III WTER;j-._...__ EXTERIOR LATH POOL PRE PASTER_-_ FOOL FENCE I _GATE SEWER SEPTIC TANK t LE L'f l Al FINALS FINAL GAS TESL HEATING • A( HOUSENUMBERS :!O_B_COMPL•EL_ED. ..-"•_. ABOVE APPROVALS 1)0 NU'I !NC= LL•DE RIGH 1 TO rUR`f ON UL'ILI'r;E ; ,7fi C; CC UPY 00LOING v Notice: Document Cannot Be Duplicated Date 3/4/96 No. 14202 Owner Name Fairways La Quinta Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE No. 78-845 Street Spyglass Hill Dr. City La Quinta Tract # 25389-1 Lot # 88 Type of Development Single Family Residence Comments Grandfatheredsq. ft. APN # 769-641-018 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area 125 Square Footage 1 No. of Units 1 V 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; 714346-6060 Name on the check By Dolores A. Ballesteros' Superintendent Fee collected /exempted by Pauline Pearson Payment Received $628.00 Check No. 02356 Signature Qi Jk P 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