9601-073 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affii�$hat 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.' 6740+74 B 713I1 A I' 7
,
Licenset# Lic. Class ,.-, Date„
Date f h .1 l 7l,� Signatureof Contractor
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 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).
O 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 sect16h('&&- 6V66 completed if the permit valuatiohli f8YV-'00.00 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 Section -3700 of the Labor
Code, I shall forthwith comply with those;•prpvision¢ .
7/ s.^. Y w �' � rI'.,�.5�, fie.'• f >"'7'°L,t +,lw.'Y' I
Warning: Failure to secure Workers' Compensation overage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and• for whose benefit work is performed under or pursuant to �u
any permit issued as a result oaf t�h� is application agrees to, & shall, indemnify
& hold harmless the City of Ir{di�nWW.,eilslits officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such'.
,permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state'that'the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection upses.
/
Signatiue (Owner/Agent) I ; , oats )b?,-, '. r% lis
A`°'
UILDING PERMIT i /
P^RMI',y�6�r�47-
DATE " ' ``
VALUATION """ " "'
LOT
TRACT -
JOB SITE ADDRESS 79„045 V SS VN CLARA .
APN 64$�_40,U,jN5
OWNER
CONTRACTOR
SPAXICS CC'1N5'T'it:( rO P
'1"M, UESEMT M`fliL OPt14lwNT LP
1.01 WA3.,STON 13CC1DG RI i NO.
P.O. DOX 1716
I..A QUINTA CIA 921.5.1
1;.AQl.i[NrA CA. 9'2253
(619)771-1941. CF3L .2996
(619)771.4941
Eq/ENG
DESIGNk',L43.iW%tff .!C,T{A
USE OF PERMIT,' Yee'riw"gs.i. y a �
T -1072B. rC~Hl',C"sOR,
LA E FORPS`.C', CA 9200 (7M ),33`!-'
R.MCHO LA QVINTA
P.AL `AC'10 PLAN I
FEE DESCRIPTION
- ` FEES
CU. I'om CO:ctiO'SIIRUC '.I014 .:3,465.€O)I 'LF
P0RCWPA.'TIG 335.00 SF
GARAGMARPoR't 608,00 SF
ESTIMATED MSTO d:.10NS')t'.Ri10CT'ION
M.2,95.80
PERMIT F1:+'E SUMMA-R1t
P1,AN (3HFCK IT: 10a-0(1<�.<3�.1'S.�t $1065.95
CO NSTRUC`IJON M 101-000-415-0110 $1,29:4.00
)vi•CC HANICAL M-6- 101 -WO -421-060 $143.Sb
DAEEC.1 UCAL FEE; 101-000-420-0010 521141
cJ`9 t ;dt`s Ivls7'i'CQa'3 F!?ks - .1: F5.11 100 -000'241 -OW
[01 -600423-WO 20.00
INFRASTRUC AIA. !s F -El: 720 40x443-342 S6,000M
PAL.CIIS1 PLAN 10! -OW -44.1-345
AR f�}' `ur%jC 1~`1,jv F;s - Rpsit 70t-000-253-000 5465.74
i
�+ USS, .PIU. - PAWFLCS .
$0.00
Lam\
! t�L Pjr,. RP 1r,�` V.S ]DU 1`1#�lir
46 .6
AN 2 2 1996
By •
-DATE
RECEIPT
BV
DATE RNALEO
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Se! Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck c
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
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. L Se of Power
Final
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District_
82=879 Highway 111
...,.,... Indio, CA 92201
Document Cannot Be Duplicated �19_,774_�5nn
CERTIFICATE OF COMPLIANCE
Date 1/22/96 APN # 649-400-005
No. 14056Jurisdiction La Quinta,
Owner Name T.D. Desert Development Permit # '
N,,: -79045 Street Via San Clara Log #
Cit_v La'Quinta Zip 92253, :Study Area .123
Tract # 27952-1 Lot # 5 Square Footage 3465. l
Tvpe of Development Single Family Residence 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:
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 Occup&,icy for
. this square footage.in this proposed project may now be issued. v - � � ...kt'
Fees paid By T. D. Desert Devleopment LTD Telephone; 771-1941'
Name on the check '' L
By Dolores A. Ballesteros
Superintendent ,�,:�, `
Fee collected /exempted by Pauline :Pearson Payment Received $5,959.80
Check No. 7663
Signature A�1 Q 6m oT�-Q-�Ad A Oi/►'�
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/Receivt Copy - Accounting
i
kh - i.jl
.C�
OF L
'�o,c A QUINTA
b.
�l� NG &SAFETY DEPARTMENT
v
� 7 u
c� �q�� ma01 i
2+INS"FjECTION REQUEST LINE
S• MANGE DEP''j m-7153
Owner T IIi. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-045 VIA SAN CLARA
JOB ADDRESS
SFD LOT 5 ,-' LAN I
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL pZ
MAIN GROUND SYSTEM
GROUND PLUMBING (, /
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
---@.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING I <
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR - -
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING