9603-082 (SFD)LICENSED CONTRACTOR DECLARATION
(n I hereby affirm under penalty of perjury that I am licensed under proGisions.of
- Chapter 9 (commencing with Section.7000) of D,visionj of the -Business and
Cn
CV W Professionals Code', and my License is in full fb ce.and effect..
O 0 M License# Lic. Class { Exp. Date
W
r ' 613161 2 97
ZDate "- .Signature of Contractor
CO °� OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ � License Law for the following reason:
Z_ ( ) 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
r 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).
C'') O I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
O cV
0)
Q WORKER'S COMPENSATION DECLARATION
p ZI hereby affirm under penalty of perjury one of the following declarations:
LO O () 1 have and will maintain a certificate.of consent to self insure for workers'
X w compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q() ( /11' ave and will maintain workers' compensation insurance, as required by
O Q Sediion 3700 of the Labor Code, for the performance of the work for which this
d LO LO H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
cb 5
J (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 forwhich„this permit is issued,
I shall not employ any person in -any manner so as to become subject to the
workers' compensation laws ef California, ar cd agree that if I should become
subject to the workers' compknsation provision s> oSection 3700 of the Labor
Code, I shall fortpwi h comply with thoseaprovision `. -/J'
M� "T�Applicant N - ,:
Date: ' 0
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 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 thiss pli ation 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 the above-mentioned prop rty or, lnspeciion�purposes. ,
Signature (Owner/Agent) Date
PERMIT PERMIT# CONTROL#
y�� c+BUILDING
DATE J7B�s�E9 VALUATION t1 4,1 N LOT " 'a - TRAC$3f�-I F' L V�
JOB SITE. li
i85 4�4A".
APN
ADDRESS - ,�t
OWNER
CONTRACTOR / DESIGNER / ENGINEER
14AMWWAYS LA QUINITA, ..
AIT"R'S GROUP
5(1 -VZ 5 rx.�r N D ':I", V1;:RSE ` - ` '
355 13121.E IC'tl, ST, #A
LA q... fN'TA CA 922553
COSTA, NtESA CA 9267.6
�i� 3'i `P1 SSSS
��i 1 fl -6 U CM -0, 3-324.
1+RAN4X GONZALFS.' A+S.90ts.
USE OF PERMIT
S1'P OL VA.'S ILY 1AVEL LING
1336 EtA.ST CCA MAIN' AVE.
-6-µ -rA-4149h r
5 1-6-6G
LA Q11NTALA IWAYS
1XI.Aid 4R
CUST011A-00N.VYR(: 7i ON 2,332.00 SF
PORC /PATIC'i 1,86.00 Sig
Q_ARA..MCAPPORT 513.4(_1 SF
EST"KATED OF CONSTRUCTION'
PERMIT VER, SUMMARY
PL AN CT C K (171i .101-000-439-3I$ g785J)S
C#: N,g.'1VXJ!" 71Q1d 'f Ii 10:1-000-418-000
•tb,ts3t:'E•ir1`i�"i.OAi. fi�'f1k: EO t-t)titl-4'2, i-U{JG '�.� �.St1
:KXC VR1C'A1,1 tl' 1_000-: 120 X17(} $.I.gS,3t1
Pi.IAII)iNO ME, 101.000.419.0M $1.51 30
s I'� .Itis. il2C1T1C)ht y w 111 D .101-000-2141-000 $'&9.42
�ttk�,1'}i9v>':�"i>6��t: �I.Gl�faii(3-/l�3-GfXi ti2u:0if
1.t T1�lt,/iz4'1'YtLtc;`.Pt.�rtf! f'k�? �Z�-t3t1i1-�i�13~3�Y.i 54.,3.1.3.65
8U.I�'IUTAL f.".•c.:ri~a:S�'I•tlr�, ION:ATI-Q) �'�,t N C�1ECK
�4,7t1Fi.Ot,
LESS PRE -PAID FEE
$0.00.
i%_U PEMIFf FEES DIVE NOW
_61704.01
RECEIPT^
DATE (� ;.
BY `/
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
OX 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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Neater 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 Notioe (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 3/1.9/96
.No 14281
Owner Name Fairways La Quinta
No. 50385
City La Quinta
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Street Grand Traverse
Tract # 25389-1 Lot # 24
Type of Development Single Family Residence
Comments
CTrandtdthered 2332 sq. ft.
APN # 769-631-018
Jurisdiction La Quinta
Permit #
zip 92253
Square Footage
Log #
Study Area 125
1
No. of Units 1
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:
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Mitigation Agreement
in the amount of 628.00 X 1 or $ 628.00
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 La Quinta Fairways TelelzhonF -
Name on the check " '=
By Dolores A. Ballesteros
Superintendent
yZ_
Fee collected /exempted by Pauline Pearson Payment Received $628.00
Signature 20� ), k
Check No. 2472
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
_ s CITY OF LA QUINTA
E•a ~ ° BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner FAIRWAYS LA QUINTA
AYRES GROUP
Contractor ti• f%R �.• 1:�::
9.6-63-082--�
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
0-385 GRAND TRAVERSE AVE
JOB ADDRESS
SFD LOT 24 PLAN 4R
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL L�
MAIN GROUND SYSTEM
GROUND PLUMBING -
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNE[
CONCRETE SLAB L
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNEC
ROUGH ELECTRIC
ROUGH PLUMBING — C
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
• IP�o�IAW�/�A 1
O.K. TO WRAP
.: r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR T
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK�-
FINALS
M to I I NU - A/G
HOUSE NUMBERS _
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/06 TURN ON UTILITIES OR OCCUPY BUILDING