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9601-069 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm 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�'.7C�i�ds's _ B Exp. Date. Date.. 1'l Al .. A/ signatureofContractor,' ,/A: I 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 withwages 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). O 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. (This section n d,got be completed if the permit valuation is for $100.00 or less). ""'A� r_ . �)�} 1 i't llXltialA () I certify VtaA tnre performance of the work for whI AMs1 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 (,.should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those -provisions,, �1 iti Warning: Failure to secure Workers' Compensation coverage is unlawful and shall( subject an employer 'to criminal penalties and civil fines up to $100,000, iri addition to the cost of compensation, damages as provided for in.Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above'information is ,correct. -I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property'for inspection purposes. Signatuie (Owner/Agent) tf { ALC0 I r. BUILDING PERMIT PERMIT;6,$-0.9 DATE. 1�lf % VALUATION $2,86,79.�T R LOT 1 I TRACT JOB SITE ADDRESS APN r 1. 79-005 VLA SAN C LARA .649-1410-00 OWNER CONTRACTOR y C /cp�+y SI���,itXCS CO)VS.11y/.l.G.i�.. i.i,C!N 'r.D. DESERT' IJL`•'VE-LO.PM%NT LP. 101 WA.LMN BRIDGE RD NO. P.O. BOX .1716 I.A. Qi7fAiTA CA 92253 LA.QLJINTA. CA 92253 (6.19W71-.1.941. CBL# 29% + DESIGNEWENGINEE R (619)771-1941 PMAP,F,.;t;G`ItAriI;Ei,I:, INC. m...n 2367213— 3.4-07R. USEOFPERMITrb. e's.�., niri'r,r.yy��S�rr,'� �w i9iL'j6.I:1'AIVt,I.L,i UWt�l.�tl��J RANCHO LA QUIN-CA �. pAL.AC'IC7 %LAN I g;K, ' I FEE DESCRIPTION .,FEES CUSCOM CONWrAUCTI(JN r). 3.46100 L1: w PO.ItCIUl7?C j'io 335.00 SE GARAOE(CARK)RtT : ; 608.00 Sr s: VlR y ViT1!MATIED COST OF CONSTRUCTION296195.80 ft It1;NNrIT YEX 8U.MMARY 5 N, � -: t�t,ANK,i MWK-11.3—F, 10.1-000.439=31:ia COYv*STRUC2IONFot-400-413-000 r t% EC-=1ANIc AL ztCt 101.000-421-000 S143.5b ` ELEC'17RICAL FEE 101-000-4,20-000 $213,44 4�fyt1fd1Cs9'rJCB 47E1s t01.000-41.9-0()0 si%.00 ,'CONQ h4ar.ION g'E1_s-18S'ID 100.000-241.00 $25.63 exitA.IJi:M( ;f11ii 101-0()0-42:3-000 $320,00 JN} RAS l'I VC,' t UR E' D-311 225-©1)() 342 KOtt A* PRUIY 1SF, P1,:AN' $x(00 ART IIV`PW IC PLACES - i2:ESW 701.0,00,255-000 $465.74 fiAL C:ONS'IRUC�r1O1 f MND PLAN C—MC% LESS PRE -PAID FEES y $9,462.26 , $0.00 ' `T0'g'A).1It'3!.FtMt1<"FEES DUE NOW FEB 2 3 S9,46216996 1 �• By RECEIPT DATE- BV DATEFINALED_ 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 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 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 OX 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 1. ' Srfioke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Desert Sands Unified Schoof District Notice: 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619475-3500 CERTIFICATE OF COMPLIANCE Date 2/13/96 APN # 549-400-001 No. 14149 Jurisdiction La Quinta Owner Name T.D. Desert Development Permit # No. 79005 Street Via San Clara Log # City La Quinta Zip 92253 Study Area 123 Tract # 27952-1 Lot # 1 Square Footage 3465 Type of Development Single Family Residence Vo. 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 -xempt 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 1.72 X: 3,465 or $ 5,959.80 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.. ` f . Fees Paid By T.D. Desert Development Telephone 771 041. Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted 'by Pauline Pearson Payment Received $5959.80 Check No., 7881 Signature Qc A t 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 - a IL�1VG & SAFETY DEPARTMENT CV p 777-7012 �4VSPECTION REQUEST LINE 777-7153 Owner T.D. DESERT DEVELOPMENT Contractor SPARKS CONSTRUCTION Permit Number POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES A SAN CLARA JOB ADDRESS SFD LOT 1 PLAN 1 TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM --GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB 'JOISTS & GIRDERS ELECTRICAL GROUNDWORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST CT t HEATING & VENT - A/C FIREPLACE ROOF 5 - BOND BEAM —O.K. TO WRAP – - GROUT ❑ 4' ❑ 8' FRAMING �l INSULATION PRE -ROOF COVER NO WORK UNTIL ABOVE HAS B EN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK FINALS ELECTRICAL 1/ (p PLYMBING FINAL GAS TEST H E,`>TI NG - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO 1/95 TURN ON UTILITIES OR OCCUPY BUILDING