9807-288 (SFD)LICENSED CONTRACTOR DECLARATION
I herEcy 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
;,.Professionals Code,-an6my License is in full force and effect:
License # Lic. Class Exp. Date
7131199
1 � /
,/Dated 14A Signature of Confractor"✓ ►
r , v `ti -
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 .
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.
M 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.
S T Al FrYNTJ 137109597
(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 agree that i I should become
s0ect to the workers' compensation prolusions. f Section 3700 of the Labor
/ode, I shat^orthwith comply with'thoseprovision .
Date: '` h h,rrS4 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 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 repressentativefs of this City to enter upon
the above-mentioned property for inspectionurpo�_es.
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ignature (Owner/Agent)
BUILDING PERMIT PERMI9807-289 CONTROL#
y4QJODATE VALUATION �(� LOT TRACT 7,298-
B SITE! . d• .•
JOB
ADDRESS . J�i2-5 i ON GA E
APN
169-770-013
OWNER
CONTRACTORSIG.NEvR(/E�NGINEER
wM1aJDi•Jiitii\pD i7YiI%vaiii
(A/�DuE{
SYP-wFrypr
P.O. BOX 1716
792.95 .k AINC}1U .LA. QVfN'1A LAR_ -
L,A QI ltXrA. CA 9d?ti3
LA Q1,31"td`rA. CIA 021:2 3
(160)77149.11 11 0311 29915
USE OF PERMIT
SIYWOLE PAMILY D-WIELLIN.01
SPD-i?El2M:IT GOES !NCLUDERILOCK WALLS OR :POOL.
AORCUT- T 1025.00 SF
GARAc rvb_AR.PoR:r 809.550 SF
CCS` OPvtC;0N,%1TtLK-)JGN 4,478,00 S
ESTIMATED COST OF C OINSTRUCTI€ N
36 7, 6615..?
PED MIT FEE S[iivlIiiAR
`
EE D13POSIT -$2.50.00
01.89-
P! iAN C1 —r1r,K FFF 101-W-439-319 %001.89-
C0NSTWJ(°TJON F.EM 10.11-W0418-000 $.1,577,50
&MCHANICA.L FU 1. 0 1 -0a. 421.000
HLEC'i ICAL FIM 101--OW420-000 $279.39
NI fi)Iv?f3 t El, 1(31 000~2189-t31iCi $2>:a0.04)
s 1'1WNG N,10nJ ON ,1: - RESIO 161 000241400 $36.77
s
QRAG:ING Yffi, 101. -000-423-000 3-000 $20,00
3t%dE1-A43-3 � .i►)U.L ISULC�(2'�FL�-0
?11I.'1'' f P1),91,1< :PLA.('ER> , 1q 701 -Wo -.255-000 $669,16
� f
`' 1, C�Jl�si"�iOCTIO!oT A1�f31 LAN CHECK
" LESS PRE-PAIDS I+EES
�1d,301.21
X2513.00
cq TOTAL F.RNi}iT +'ERS D[l:tr;NOW
9�19.(ISi.21
'RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
p-
Underground Ducts
Forms & Footings
- d
Ducts
Slab GradeC/
sel
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/
BLOCKWAL APPROVALS
POOLS =SPAS
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
Sewer Connection
Pool Cover
Encapsulation
Gals 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
1
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Final
Utility Notice (Perm)
COMMENTS:
�OU/' °�%��► f.�1
Desert Sands'Unified School District
47-950 Dune Palms Road '
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-7714515
CERTIFICATE OF'COMPLIANCE: r
Date 9/4/98 " APN # `.769-770-013
No.. 17645 Jurisdiction La Quinta
OwnerNameLa Quinta Orchard Partners Permit #
No. 79-425 Street Stonegate Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 4,478
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of.
1.93 X 4,478 or $ 8,642.54 the property listed above and,t d: bu l'dmg �.
permits and/or Certificates of Occupancy for this square footage in this proposed project maynowbe,issued
Fees Paid By CC/El Dorado Bank/Sparks Construction-JudyTeiphone 77I X1941 `rJ
Name on the check, t ;
By Dr. Doris Wilson ,'a'�r�•�"/z
Superintendent
Fee collected /exempted by Juanita Green. Payment Received $8,642.54
Check No. 851318227
S' nature
tg
E: pursuant of Astmbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day ;approval period in which you may protest the fees or other payment identified
will begin to run Vom the date on which the building or installation permit for this project is sssued or on which they are paid to theDistrict(s) or to another public entity authorized to
them on the Disbict('s)(s) behalf, whichever is earlier.
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
W v c> :i
`y.
City of La,Quinta
Developers Project Approval Form
e
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
qfter approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: 1 Single Family Dwelling
Rancho La Quinta (Estancias), Tract 26524, Lot 35
Applicant Contact: Nolan Sparks, Sparks Construction, 771-1941
Application / irculatio Date: ZZ�48
Date
Community Development Department
******** PLANNING DEPARTMENT APPROVAL NOT REQUIRED ********
.ti
Christine Di Iorio, Planning. Manager Date
Public Warks Department
Steve Speer,
Building and Safety Department
Mark Harold, Building and Safety Department Manager
Health Department
0
Date
Fire Department
Date
Schools Fees Paid
Date
ate
Inspections
Garand Lane Suite F
"7J Palm Desert, CA 92211
INSPECTIONS Phone: 760-345-5554 • Fax: 760-772-3895
Project Name-
G n C 1 All tt .
L, . G=
Project No: Date: �1 A
- c7c - -19
Project Address:
C, '
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UBC ---Title 24 Other:
Client:
Sub -Contractor:
B.w �pnc�P e n
Weather:
5L&r1 I GI
General Contractor:
prc
Architect:
a
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Structural Engineer:
Locafion f Samples:
�acn.b`Nn Is, P r t,&<re
Welding Process / Electrodes:
-
Slump (inches): supplier.
Time Sampled: Mix Design::_
Time in Mixer: (min.) �Specified, S rength:
Water Added @ Jobsite: (gals.) A-dmixture:
Concrete Temperature: (°F) Truck #:
,Ambient Air Temperature: (°F) Field I.D. Marking:
Welders:
-- .._,_-
Description of Work Inspected:
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Y� O r% [ C iP a.e.
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I hereby certify that I have inspected all of the above reported work, unless otherwise noted, and to the best of my ability I have found this
work to comply with the approved plans, specifications & applicable building laws. Final report issued at project completion. Page of
Inspector: - Q ``��t ZC
Conttrra%ctor's Representative: ✓
Copy 1 JCM Inspections Copy 2 Project Superin endent Copy 3 Governing Agenc-
a