0202-241 (SFD)LICENSED CONTRACTOR DECLARATION
•=l 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 #p yIp y q LLic..�gClass Exp. Date
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Date! ; { 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).
( ) I, as owner of the property, am exclusively contracting WIi11 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 > A pf Policy No. _ 1 8
(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 Sgction 3700'of the Labor
Code, I shall forthwith comply with those provisions.
Date: 4'4'4%1d Applicant I' -
Warning:
_Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. e
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify,.
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is .not commenced within 180 days from date of issuance of such'.
permit, or cessation of work for 180 days will subject permit to cancellation9
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prop—yforAinspection pd$oses.
Signature (Owner/Agent) ' ,,, t _ _ ' Date
s
;
BUILDING --PERMIT PERMIT#0,202-241
LOT TRACT
DATE , f / �1 VALUATION ?.
.34 652A }
JOB SITE,
ADDRESS ;"C'1 NST `a :{LidV'.R'.r4h7ERi _.;
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OWNER
CONTRACTOR/DESIGNER/EN INEER
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SPAIUMMZlTIMM"I'low
P.0.00X 540'
79t,%295 RANORC) I.A. QLIMADR.
LAI UiV�" A CA W253
1:US�1`A $:F§.d .
�OY7711.94 of .996
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USE OF PERMIT
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IS1914 PRE -MO) FRES
-3250.00
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JUN 18 ioul
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RECEIPT DATEf f
t7
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION4*- .
DATE
INSPECTOR
- BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
gf Q- I - eL,
Ducts
Slab Grade
etum Air
Steel
Combustion Air
Roof Deck
_ �b2
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 �y j
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
Gas Piping
4; PLUMBING APPROVALS
47
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 L
Underground Conduit
Rough Wiring -
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
WHO Notice (Perm)
COMMENTS: S43��
t�Tiv S "cif i��4 S 11/1
Desert Sands Unified School District sxk1E17sC
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Ir BERMUDA DUNES
Document Cannot Be Duplicated 760-771-8515 - f" RANCHO MIRAGE b
Y INDIAN WELLS
PALM DESERT
CERTIFICATE OF COMPLIANCE NDIO QUINTA
Date 6/18/02 APN # 772-040-012
'No. 23304 Jurisdiction La Quinta
Owner NameLa Quinta, Orchard Partners Permit # 0202-241
No. 50355 Street Woodmere Log#
City La Quihta - Zip 92253 Study Area
Tract # 26524 i of # 34 Square Footage 5467
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
2.14 X 5,467 or $ 11,699.38 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 CC - Judy Halpain, Sparks Construction Telephone 760/771-1941
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott Payment Received $11,699.3.8
Check No. 246013.22
Signature
NOTICE: Pursuant to 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
above 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
collect 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
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Nedjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑`HER ,
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCAT
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REL•ORT SEQUENCE N0.
TYPE O� ,
�
PERMIT NO
DAJE
dAY OF WEEK
MATERIAL DESCRIPTION I
ARC ITE M�`�
f�7I� ll.� I
INS ECTOR
6
HRS. CHARGED
ry
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE -
GENERAL
_ ,, , CONTRACTOR _ -., _ . f
SUB
_ CONTRACTOR
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trS �. S ate'. s
OLS
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COPY SENT TO CLIENT O
COWIN ON NEXT PAGE O
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I' HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS.- AND APPLICABLE SECTIONS. OF THE
GOVERNING BUILDING LAWS., ,+ i
I N URE OF REG6TERED INSPEC R
ATE OF REPORT REGISTER NUMBER
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,This Certificate -is issuedrpursuant to ^the requirementsW-Seetion 109 of the California=Building
certifying j at, at --the , time of issuance, this ,structure was int^compliance with ithe '
,Code,'
provisions, `of thd' 'Building -Code and the ;various -ordinances "of th6' .City ,regulating building
f .,construction and/or use
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,This Certificate -is issuedrpursuant to ^the requirementsW-Seetion 109 of the California=Building
certifying j at, at --the , time of issuance, this ,structure was int^compliance with ithe '
,Code,'
provisions, `of thd' 'Building -Code and the ;various -ordinances "of th6' .City ,regulating building
f .,construction and/or use
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-• �' •. BUIL-DING ADDRESS: 50-355waobMERE x . -
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' Userclassification: SINGLE'FAMILY DWELLING ' - �< '- ' =:, : r Building Permit No ` 0202-241
, _
Occupancy G'ioup: R 3 ``^` --� �'• `' of Construction: t V -N -; Land Use Zone'`R L
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,. Owner of Build_ i ' LA QUINTA ORCHARD PARTNERS Address -00'130X:540,,}` -
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City, ST,: ZIP: LA QUINTA CA 92253
-
`. �~,, • :�' ry By: GARY SHOWALTER
� -'ted : ;' •`'
it rPate:.:11/25/2003
`�
.,'Building Offici r
`
POSTINA CONSPICUOUS -PLACE 4• _ ; T