9808-227 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby 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
/Date �I Signature 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).
-k) I; as -owner oftheproperty, 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.
(�) 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.
STI 1 °rr M3 04�48.0N i 4fS1CI7338
(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 provisio s of Section 3700 of the Labor
Code,I shAll forthwith comply with thos prov' io 'S. ,
Date: ✓ / 1.,y �4 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'upori 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 representatives of this City to enter upon
the above-mentioned property for inspection purposes
1 3
Signature (Owner/Agent) t` "'F3""""""'"'_ Datef'1 �/''_
V ` i•
BUILDING PERMIT. PERMT# '
"
9848-227
l r
DAT VALUATION g , LOT TRACT,'JOB
SITE
ADDRESS we -11,60 WOO DINWH .i •'
APN , 769-760-003
OWNER
CONTRACTOR / DESIGNER / ENGINEER �• '`.
6 AQXY,1 r,1k, QKC1'APM PARNI I:E S
SPARICS COr1MUC,' ION
1'0 ;13ox 1716
79-2,95 'IvA;NCHO 1.A QUIN [tLl: R..
L..A (fit 1"iNTA C.A. 92253
L,a°►. (;t1Q:IVFA CA 92253
[764)771:4941 _ - C;IM,14- 1998`...
USE OF PERMIT
SP
00.00 ST.,
'
CARAGEJt:ARP010' tft?a X10 8
rA T IMA TIM COST OF CONI S`8'nwUr"HOIN
267,295..40 .
•MA FEI.F3. aJjvaAIt' R-
Cf:NS7'R1JCt'_13N FW,7 101-000-4184)00 31,227 .50
1'LANCt 1t�>5."I c:' - :T 101-000-439-3IS _ 31,c��#.5►L
- - -
t"�C�131�!''C�S7T 101...0011-•4'�,.3j,�;-:�250.C�f)
�4i1:� ldtiN!'Ca T. f i Ia 10140-4-21-000
140-4-21-000 ;tSa,Ssi
Ei.L+w'.rkIC� L M 101-010-0-420-00()
KY.S,M1�(. WG tTI,E 1;01 -OW -,419,000
011+7NO N1OIJONf s'•'i~'C -R13SID 101-000-241 -000
0R.iiDW0 VEA:
1NFKAYrTJ.1 f IGl:'t3RE;FE 225-00-443-342
Ru °it 2jjkF( t1 f4."1t„iR a3 t R.T{1�(:I�
Vic!iRl3,'1�
9YOTA1,PIC NOW
_V47 Z
RECEIPT
DATE 0 it"! `�'
DATE FINALED
INSPECTOR
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.
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
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School. District':
47-950 Dune Palms Road
Notice: L_ a Quinta, CA 92253
Document Cannot Be Duplicated 760-771;-8515
` CERTIFICATE'OF COMPLIANCE
Date 12/29/98 APN # 769-7607003
No. 18183 Jurisdiction, La Quinta
Owner NameLa Quinta Orchard Partners Permit #
No. 50-160 Street Woodmere Log #
r City La Quinta Zip 92253 Study ,6ea
Tract # .25674Lot # 2� ' Square Footage 4;530
Type of Development Single Family Residence No. of Units 1
Comments
4
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
i
This certifies that school facility fees imposed pursuant to Government Code 53080 qui llae amount of
1.93 X 4,530 or $ 8,742.90 the property listed above aniihat building
permits and/or Certificates of Occupancy for this square footage in this proposed proje]/ct may no-: be issued r`
Fees Paid By CC/Eldorado Bank/Sparks Cons. - Judy Teepleon,a '771 X1941
J
Name on the check
By Dr. Doris Wilson. tai �Ya
Superintendent
Fee collected /exempted by Juanita Green Payment Received $8.742.90
Check No. 85131859:
Signature
FNC.E� Pursuant of A embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 day approval period in which you may prole:t the fees or other payment ident ed
ll 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
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 wavers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
IF
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
Dear Builder.
Prior to issuance of a- building permit, you will be required to obtain clearance from the
Public Works Department for one, or more, of the following:
1. Verification that rough grading is complete, and the pad elevation 'certifications
prepared by a licensed surveyor, or engineer, are on file in the Public, Works
Department.
2. Verification that infrastructure improvements and other required t` -act improvements.
are complete, or sufficiently advanced to warrant building perrrit issuance.
3. Prepare an engineered grading plan that provides for on-lot.StOfm water retention,
and have it checked and approved by the Public Works Department. '
• Tract 26524 (Estancias) t '
• Tract 26769 (Mountain View Estates)
4
4.' Prepare an engineered grading. plan, that provides for buildi-ig pad. grading ,in
accordance with the, existing soils report and tract- grading plan,, and have it
checked and approved by the Public Works Department.
Tract 28034 (South Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT: LSI
LOT:
PUBLIC WORKS AUTHORIZATION DATE
FAPWDEPT\DOCSIFORMSIPW CLEARANCE LETTER.ss
/ �� : COMMENTS -
Fr _
TRI-STATE.LANd.SURVEYORS &CIVIL ENGINEERS
78,120 CAME ESTAdO, SUITE 102, LA, OUINTA, CALIFORNIA 92253
(760) 564.0271 .(800) 363.•6306 FAX (760) 564,0274
December 10,-1998
Mr. Marcus Fuller ;
CITY OF LA .QUINTA €,
78-495 Calle.Tampico .
La Quinta; California-92260 .
RE: Pad Certification - t
The Estancias
Tract 26524; Lot .2
Dear Mr. Fuller:
This letter is to`certify that a field survey was made of the existing.pad in the City. of La Quinta.
Lot 2 of Tract 26524 was found to be in" conformance with the approved Grading-Plan. '
The following are the results "of our survey:
LOT # PLAN GRADE MEAN ELEVATION
2 z 49.00 49.06
If you have -any questions, please do not hesitate, to call.
` Sincerely,
Peter G. Ringeis `���Q�, ®'� ��• ,���
\ '0
RCE 13515n% :
X,
OF GW\1 ��
• 1 '
WALLING S. McCALLUM % LIMITED
ARCHITECTURE • RLAN"NINO • ENOINEE+RINO
45-190 CLUB DRIVE 1760) 3ED-0250 -
INDIAN WELLS. CA 92210 - , . FAX (760) 3E0.0766
t F
i
4, # a k
• �. • ...11x1• x
{
July 22, 1999
Mr. Mark Haroldits-7 ,1
Department of Building & Safety ''t *`'r
• CITY OF LA QUINTA
Post Office Box 1504. fy
La Quinta, CA 92253 '
1 RE: The Estancias
Lot 2 ' • .. �}c. � ,. , , -
r" La Quinta; CA
Dear Mark
I have inspected the trusses at the master bedroom entrance, and even though it differs from the
fi•aming plan, the installation is sufficient to maintain the structural integrity of the roof system. ,
Yours 'truly,
Jo G. Walling, A.I.A.
. r
• c. - - yrs � .
°