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LICENSED CONTRACTOR DECLARATION
".1 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
r"i�tt �� 6 33 +;/ia`yn
Date`? 1 l ) Signature of Contractor~�� �r�
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.
( ) 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 v q . Policy No.
.l:..f 3A1"fl`L Y
(Th' s section need not be completed if the permit valuation is for $100.00 or less).
(I,� 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' compensati
forthon provisions of Sectio 3700 of the Labor
Code, I all with -comply wit os� pprovi ions.
Date: % � pplicant ��
Warning: Failure to secure Workers' Compensation covetage 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 representatives of this City to enter upon
t e above-mentioned props y for inspection p poses.
.
Signature (Owner/Agent) '� Date~ /
w
BUILDING PERMIT PERM';,�,� �;�� CONTROL*
5911l�
DATE VALUATIONS i.`7< 8.3 li, J 0LOT TRACT
q/0/11 0
JOB SITE
ADDRESS 174>ti�iJ�!Udi�'��,f.il,A., 7
11"•234)07
OWNER-
CONTRACTOR / DESIGNER / ENGINEER
6)R 1T '1/t'-14Jt Y. �!
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l..fi.QUTA I -A CA 92233
f:'A"1101131;L8..CITY t.A 922-114
(76 0112 AS C M.m 479
USE OF PERMIT
AMA
sift § $-P. ; ..710 ?ID ' t r:; R i .MMA ION 'CC) i:MS IN4� IRXISJ7?,
A6JDl,, I1104`f
ITSTItiIi`l..L ED �w>1# CA? M.+ONL IN�N.•D1V�i.. 1011V
pmm.a, If A BPA $U;V. i'tik1.€w
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.
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h11111 !`h`fCAM.'i FIT it) iw.%"iti 42G -Quo $40AS
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a j,}it~ti �+7
LESS P-116-PAIDF'BESS
QCs ry'3
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
JA^
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
9A.1111
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
v
Exterior Lath
DrVMII - Int. Lath
q'7
6
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
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:
I
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. OLUMDING FEES
:ST FI_. S,] FT ,r i
UNITS
UNDERGROUND
Ar— UNIT
COLL AREA
YARD SPKLR SYSTEM
2ND FL. SO. FT..S
BONDING
HEATING (ROUGI»
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR SO. FT A:
DUCT WOW
ROCK STORAGE
GAR. SO. FT. d'
POWER OUTLET
ROOF DRAINS
CARP I jO. FT -4
OTHER APPJEOUKR
DRAINAGE PIPING
WALL SO FT 'd
TEMP. POLE
DRINKING FOUNTAIN
_ SO cT. v
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION S
FINAL INS/.
WATER PIPING
NOTE. Not to ba :sea as proceny :ax ra:uanon
WATER SYSTEM
FLOOR ORAIN
MECHANICAL FEES
=s
WATER SOFTENER
VENT SYSTEM F.AN EVAP COOL t+000
SIGN
WASH ER(AUTOX O1SH1
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT •WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN SINK
ABSORPTION SYSTEM B.T U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. 40 c
BATH TUB
SPARK ARRESTOR
SO. FT. n c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SU. FT. RESID 4 114 a
SEWAGE DISPOSAL
LATHIlq
SO.FT.GAR D 344
HOUSE SEWER
MESH
GAS PIMA
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMS. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING S AIROON01 SOLAR
SETBACK.
GROUND PLUMBING
UNDERGROUND
Ar— UNIT
COLL AREA
SLAB GRADE
ROUGH PLUM\
BONDING
HEATING (ROUGI»
STORAGE TANK
FORMS
SEWER OR SEPM TANK
ROUGH Mrs"
DUCT WOW
ROCK STORAGE
FOUND. REINF,
GAS (ROUGH
METER LOOP
MUTING (FINAU
OTHER APPJEOUKR
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INS/.
BOND BEAM
WATER SYSTEM
GRApNO
CLL p,
= py d
=s
LUMBER OR.
FINAL INV.
FRAMING
FINAL INV.
ROOFING
REMlhim
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHIlq
MESH
INSULAT)OW80UND
FINISH GRAOING
FINAL INSPECTION
CERT. OCG
FFNCE FINAL
INViCTWfi fIW�ATYI1WNUilKi .
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 9/17/97
APN # 604-221-007
No. 1(J093 Jurisdiction La Quinta
Owner NameTerry L. Voyles Permit #
N0.78650 Street Forbes Cir..
City La Quinta zip 92253
Log #
Study Area
Tract # Lot # Square Footage 985
Type of Development Residential Addition 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 985 or $ 1,812.40 the property listed above and that building
a
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By cc/Provident/Spencer Construction Telephone •
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson
Signature )9
Payment Received '$1,812.40
Check No. 602560
10TICE: 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 dale 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
ollect 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
CITY OF LA QUINTA y
SUB -LIST
i
CSP.! / NGCONTRA TOR fAD
OWNE � JOB ADDRESS 6,60 A
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place.
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any changes to this list must be approved the
City of La Quinta Department of Building & Safety DI& to work being performed by a changed sub-
contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit.
CARLOS ELIAS
REGISTERED CIVIL ENGINEER
38825 Charlesworth Drive
Cathedral City, California 92234
Telephone (760) 328-7271
September. 6, 1997"
City of La Quinta.
Department of.Building & Safety
78495 Calle Tampico
La Quinta, Calif: 92253
Gentlemen:
This letter concerns the residential addition to be construc-
ted at 78-650 Forbes Ave., La Quinta, California.
_ I have reviewed the layout and bearing points df -.the
roof trusses des.igned by Spates Truss Company and find that.
their design is in conformance with'my design intent.
Very truly yours,
Carlos Elias
CE: j