9512-091 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm that t 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
Date Signatureof Contractor
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 J$ec. 7044, Business & Professionals Code).
( I, as owner of the property, am exclusively I contracting with licensed
contractors to construct the project (Sec. 7s0-44, Business & Professionals ale).
O I am exempt under Section ` , B&P.C. for tbiss aso ' /
/Date Amt 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).
( JA certify that in the performance of the work for which this permit is issued,
I sha11 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 0-I'SOction 3700 of the Labor
Code, I shall forthwith comply wi Otho provisio s. t//J
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 this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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 wcrk 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 represen we-s-of�this City to enter upon the
above-mentioned property for inspection puoses.
,�Signalure (Owner/Anerrt)
A`°'
:r BUILDING``PERMIT
PERMITy���ly�-.
DATE ' Ing
VALUATION;; $1x42,44 i.�a� LOT _12 1,
TRACT
JOB SITE ADDRESS
'iJfii.
APN
7)li- �i A Ir iii i3t 1'i�
769-Wi-002
OWNER
CONTRACTOR,
Oirgr_-11 k' ILDER wma-StiJulSf'• .
DAVII'f3.BEALE
WT; COUNTRY CLUBS DR.' #9)2
PALM DESERT C,,A. 92260
DESIGNER(ENGINEER
(619)346.5358
�n'�'9F?t.S 1?1rStGN "
80720 SASIMMi LA'IrE
USE OF PERMI S NGLC 17AA11L Y T. WELLUNIG
•.
kryw V, d t.0 LY) .3"+z.-YUJ0
1'anna,111CttI&V 110 If of 61 gm. -deft wall. (11wk. wtjll turd Sidc r:oturns) .Pool alio/oA'retaittllig Evall impToiN to
be ottahted iseltau only.
FEE DESCRIPTION
FEES
'fl..IAGF C;0Q,.,,T 1JC CION 'Z 260AA) SF
PORCH/PATIO 9x6.00' SF
GARE•1CI&CA.RPORT 811.40 SF
i
iF.,STI (t ATED COST OF Ci9NSTRU iON
144,640.40
VVIRMIT PCE SUAII V.1ARY
P1. AN 4'REC:K V.f%t•, l[ll {1(i[I-1Z9-:i]R $682,12
CONSTRU1717314'FEE .101.000.418-000 $7100.00
Ii C;1'[FiNii A% FEE 1,01-000-421-066 S91f)(i
EL1?C'1'R1C;Al, FU, 1.01-000-420-000 $167.82
P111l"'ITNOF"T 101 -000-419-W, ?n�.?g
CY)
D rn
SIM NO i 07"J UN F 7'.TT, ' if Sw) 100-000241GW $14.26
`_-
01ii,a,l.l NG CSE V I ^liLi1!-Ft� iitJ dSV.V�
r -+
li�T+.tZA I'i t1_Ii "1't;Jt2 FEE 725-000-44+-342
PRIViri,M fat,A N 101-tl(}f►-44t- i F�5.00
+::lt71' 1I4 PUBLIC 701-000.255-000 �41i{y.60
I. IE I5'%4 WI T -52$0.00
�
SUB -TOTAL CONS 11tUC7, .0N AND PLAN CHECK
$5,225.86 '
i CESS PRL -PAID FEES
-$2.50.00 ;
1,*O'rA't, P .RMT .. x� 7,3rn'i t)'U—L NOW
$4,975.86
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs (i
Underground Ducts
Forms & Footings 120,
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
s
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
'Approval to Cover
Equipment Location
Underground Electric
Under round Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
if y
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
Gas Test
'-Aces
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
Utility Notice (Perm)
COMMENTS:
— 1 '1 If y r LH W V 1 IV'1'H
%1l INNIZZ�%�wY Address
Owner
This form shall be posted on the job with the Building Inspection Card at all times is
conspicuous place. It is the responsibility of the General Contractor or the Owner/Buil
to monitor the sub -contractors that are on this list are the same persons performing
work. Any changes of this list must be approved by the City of La Quinta Department
Building and Safety prior to work being performed by a changed sub -contractor. Failure
comply.will result in a stoppage of work and/or the voidance of building permit.
TRADE
SUB -CONTRACTOR NAME
CONTRACTOR'S
LICENSE NO.
WORKMAN COMP. CITY BUSINESS
NO. ON FILE LICENSE NO.
GRADE/
EXCAVATE
f1
lJ
PIPELINES
M
2
o 3�
CEMENT/
FOUNDATIONS
CEMENT/WALKS
& DRIVES
ASPHALT
FRAMING
lb
STEEL/
STRUCTURAL
MASONRY
O
PLUMBING
kAf
7
LATHING
DRYWALL
11
PLASTERING
HVAC
ELECTRICAL
ROOFING
UG_
SHEET METAL
FLOORS
GLASS/
GLAZING
INSULATION
SEWAGE DISP'
PAINTING/
DECORATING
f�
�J
TILE
1�
CABINETS/
INSTALLATION
1�
ORNAMENTAL
METAL
FENCES/
BLOCK WALLS
LANDSCAPING
11
OTHERS
Desert Sands Unified Schooi District
5.Z -5-1y t`"afig$fiwaiy -L.1 IL
_ _ _ main- rA 92201
mel—It "ii t�Tiiil lie Vu -al.
iiuvi.illlVll�, v u },uv .eCi � � ®_•i•7C •YCQLdL
UENKIar1;-A1ty+ Uig k-Ur'irl- A :XPi
_PN ;tet 76c, i i -1 P. i'% -sl
arl by
No. 0421 Jerk( iction La i►iiinfia.
nwnpr Ngme David Beale
1
7 85)15 vtr 4 Avenida -ultimo
tv LCl
a uir�ta
Tract #
Lot #
-P r[Y' ,
iiia 92/253 Studv Area 123
Square IF'anet:age LLJV
Tvnv of Deveionment Ningie r amiiy xesidence No. of Units .1
At the present time, the desert Sands Unified Schooi District Cities not collect Tees on
,garages/carports, covered patiosiwaik-ways, residential additions under TUU suuare Leet, detached
accessory structures or repiacement miobilehomes. it has been determined the above-named owner is
exempt from paving., school tees at this time due to the following., reason:
EXEMPT ION NOT AF-TiACABLE
'his certifies that school fgcil_ity $PPs iil'1_nosed pursuant to Government Code 5"50
in the.aniount cit" f."/Z X 2,260 or $3.887.20
the hroherry listed above and that building hermits and/or Certificates of Occunancv for
this square footage u -i this proposed project may now be issued. _ �• „ : :� " i�
;Fees:aicBY IDa.vid.Male
N=e on the checkIL
By Dolores A. Baifesteros
Superintendent ;
Fee collected /exempted by Pauline Pearson- Payment Received
Check No, 103
S.gnatjre A YD M p
Coiiector: Rttacie a cots of counts or city pian cssect: appucation foram to district coP3 --or aii waivers.
En-ftssed Originai- -En ijdirg i'.-v-.JI%vj) ic,.ni CORY - ix; Vnca.nt/KeceiVT Copv - Accounting
Received F
Address:
Account N
Service Ad
CI Qeter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ MeSurcharge
tionCapacityCharge r
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract-
Fee
ract-Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
L
Remarks:
❑Copy to:
Cash
Check
Money /
Order
$
TOTAL s
Water Service
Cashier
D 438 (11/89)
L
-4
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 24, 1997
David J Beale
78-515 Avenida Ultimo
La Quinta, CA., 92253
RE: Single Family Dwelling Permit #9612-091
Dear Mr. Beale
The purpose of this letter is to inform you that your Single Family Dwelling Permit #9512-091,
for the project at 78-515'Avenida Ultimo, has expired. In accordance with 1994 UBC section
106.4.4, no further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new*permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2). Notice of non -conforming structure placed upon property profile.
3) Action filed with. Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Buildi g & Safety Manager
Daniel P. Crawfor Jr.
Building Inspector I .
cc: file
dpc
MAILING ADDRESS - P.O. BOX 1504 -.LA OUINTA, CALIFORNIA 92253
i
of 1.4a Quiuta
t t
tttult
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code. certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
?
BUILDING ADDRESS 78-515 Avenida Ultimo
Use. classification Single Family Dwelling Bldg. Permit No. 9512-091
VN
Group R-3 Type Construction Fre Zone Use Zone R-3
'
owner of Builiinq David Beale Address 73 -373 --Country Club 'Dr. #902
City Palm Desert Ca.., 92260 B Daniel P. Crawford Jr.
y
f
Dote: Temporary Expires 6/6/96
_
Building Official
_-
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