9702-072 (SFD)LICENSED CONTRACTOR DECLARATION
I herQby 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, and my License is in full force and effect.
License # Lic. Class' Exp. Date
47.')-
13 7 3119`TDateS'ignature of Contractor'"' "�',�
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.
1 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'rATE rUXD 1'37109596
(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 if I should become
subject to the workers' compensation provisions of Section 3700 of the abor
Code, Is l all fortQth comply with tho - provisions. %
JDate "� Applicant �-^ 'S �"'v�"'..""
Warning: Pailure 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 persowati
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 ffiori0spection purpoo S. ,�'"
Signature (Owner/Agentj� � �' ""�t 1Z Date" Z4_ X
BUILDING PERMIT PERMTk °°NTR°`"
`�
9�w1"°t.�►"7.2 5 313
DATE VALUATION LOT TRACT '
,,97 1,95'7.3 2Co5 2a
JOB SITE
ADDRESS 79-:324) S t ONi! GAT ,
APN ' . 769-760-020
OWNER
CONTRACTOR'/ DESIGNER / ENGINEER
I.A. QU1NTA. 011CH.tlt M P
SPARKS C";ONS"t RUCION
40,55 COOK SY'4m
'79.295 RANCHO 1,A Qit1NTA D.R.
PALM DESERT CA 922111
LA. QIANTA. CA 92253
f7 0:T7�1,-3rJd1 C13114 2996
USE OF PERMIT
SPE)
S4�ia t stcE4i1°i i:i0818 N01 .14CU.U6 3i1,Wik: WAx.1.. taT2..1* )Oi_
C'013TONI, C01,43`1TIZUM10N 4,611.041 yr
V NtC0111JAXIC) 600.00 SF
t{AKAGOCIARPCiRT 749.00 St
'OFC
,S3I fiAC D x>IJLICj
381,M7.30
CON11511RUC'911ON FER 101 -000 -4.18 -OW $1,626.50
P;LA'N CFS' Pi.:E; 101-000.439-3111 $1,11MAI .
rtE
svil:c:'1 �t�rtc �t�..t s 1011-iictt21-001 $tit •s�3
°
PJ lzMIC.AL FE 1.()iOW420-000 5282.97
Pt,l M -FINNY rE.11 loi- 00-414.(?pl? $274.50
STONG ;�d0110N FEC - RES115 101-000441-M53$:19
0, RAIl1.NG k`81i" lfll-1100-X23-Ot�li . S20,00
s
1WRAS`1.R.tAM3f• R FEE t' 1f25.000.443-342 46,000.0o
AFT IN 1''ormc P?.Acx1 s - Hum 701..-w-2.55-000 $704:64
`5�1'C?TAI. CC7tet 1'R t1 i'1C)i .�NZ? PLAIN CHECK
$10,42&37
LES PU-PAID FEES
-$1,000.40: ,
JUN 0 5 1997- TM AI,1?N.RMY'V FEEN AVE ONV
RECEIPT
DATE i
BY`
PATE FINALED
INSPECTOR
AL.
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
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Faris & Controls
Party Wali 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 Pibg. 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
Final
'Utility Notice (Gas) .
ELECTRICAL APPROVALS
Temp. Power Pole
'Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
a
�
CITY OF LA QUINTA
or a� BUILDING & SAFETY DEPARTMENT
777-7012
w ►�C��INSPECTION REQUEST LINE
777-7153
&r►er LA NTA ORCHARDS PARTNERS
Contractor CONSTRUCITON'
Permit Nur'lb r 9702-072
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-320 STONEGATE
SFD ONLY 6 ,
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING i
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIC NED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST -/
HEATING & VENT- A/C
FIREPLACE
ROOF �i
BOND BEAM
O.K. TO WRAP,
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNE
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
�02L-KNCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST 1
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
Lzz—
TEMP POWER -
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
7/96 TURN ON UTILITIES OR OCCUPY BUILDING
. uutiicv o2
��
5,ro�`/� G!1 l e P.O. BOX 1504 APPLICATION ONLY
78.105 CALLE ESTADO
Address �d ' .� �S �ig/�� / $ LA QUINTA, CALIFORNIA 92253
LA !el/ef/ 1".f
Mailing \
Address P6 �3!
City Zip Tel.
/9z//
Contractor
Address
City lZip ITel.
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thaf.he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Fj 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I 1 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i l I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
r] Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agreeto comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 791- 714o - o2 -t9
Legal Description
Project Description
Sq. Ft. %� No. No. Dw.
Size f Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
,S 1.4 9/ r ,y
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS t
v
ZONE: BY:
Minimum,Setback Distances:
Front Setback from Center Line
Rear Setback from Rear4Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE RA INSPECTOR
Issued by: FEB 11
Di§Permit
Validated by: p
Validation: ni3U PIC I B ill 1'NT�"i
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUM19NG FEES,
1ST FL. SO. FT. � $
2ND FL. SQ. FT. (Fy
POR. SQ. FT. a
GAR. SQ. FT. @
CAR P. SD. FT. 0
WALL SQ. FT. @
SQ. FT. g
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID p 1V. c
SEWAGE DISPOSAL
SO.FT.GAR n 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
jPL.CK.FEETOTAL
PERMIT FEE
PERMIT FEE
DBL
FEES
MICRO FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.cu.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
_
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
,Notice: 82-879 Highway 111 .
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/4/97 APN # 769-760-020
No. 15595 Jurisdiction 'La Quinta
T
Owner Name La Quinta Orchards Partners Permit #
No. 79320 Street Stonegate Log #
City La Quinta Zip 92253 Study Area 125
Tract # Lot.# Square Footage 4611
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
1.84 X 4,611 or $ 8,484.24 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 oc/Eldorado Bank Teleplione`,:771-1941
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $8,484.28
Check No. 726185746
Signature PoS , A Q n A1.2.
U i 4 �l;lil�tl P�/vl
OTICE: Pursuant of Assembly 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
bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
3Ilecl them on the District('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
a