9601-087 (SFD)LICENSED CONTRACTOR DECLARATION
I figreby 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. 671074 . B��1�5rf-i
License # I Lic. Class Exp. Date
Date ,>f� , /n /_ Signature of Contractor �
t� U/
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).
( ), 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 Policy No.
(This sect&.14edino'ttb completed if the permit valuatioh i"s f$1)$1'Im.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 provisio s.
Date:. ! .y A ,Applicant
Warning: Failure to secure Workers' Compensatio�r rierage 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 application agrees to, & shall, indemnify"
& hold harmless the City of Ind'iarifflelly Ai '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 n>� tion,prrpbses.• '
Signature (Owner/Agent) ' , �f j -Dame j1-77 C2i
CU f ilk•'
A"'
—
eT.D.
_ �.9BU,ILDING PERMIT
rt�PERMITi��r��_
DATE n'm r '"
VALUATION o' .r'..w`.�`.`ry LOT `'
TRACT
JOB SITE ADDRESS • ' 7.9400 VJA SAN CLARA
APN G4944WU119
OWNER' .
CONTRACTOR
Si?;/1.R)e.S C(3A1':1.4tU("''•'1`!Ol`I .
�1~s .� t���iy .c .iti !° a.,
101 `vALSTON BRIDGE RD NC
I.O. BOX 1710
L,A,C�UrN'1'� i tl 92G53
Lia QUIN'1:'A CA. 92253.
(01.9)771-.1! 41. 031,46 1946
(619)771.-1.941.
DESIGN RIENGI EER
CRA, IDELT, Mr-
s.ir.T /qT n
236 WRTOcGA.3R,
USE OF PERMIT"" tuiRur.e szt us:.ai•
ir.A>tiEFOR138TCA:02630 C14)flsr=i
RANC140 t A QWNTA
I?1LAC10PLAN t
FEE DESCRIPTION
FEES
CUMP-4 P-4 C;ON "TRUC .10N 3,465-W fN_h"
sti.
PORCI-Tlt''A` 10 333.00 SF
i
t3MftG3r1%/CA"0l'gTr 608.00 S.F
F.STEVATED COST OF CONISTRULPT:1{ON'
28("295.so
PERMIT FEE SUMMARY
PI.A- N C iFr__K ii"o.,:I 101 -MO -4V-3183 S3.065..��5
�Si.��
9'@ i.i1t
CONSW ETON FEE: 101-000-118-000
iN1,ECHAN' TCL FW1 101-000,421-666 $143.50
FJ fi1C`l1kICAJ..HM 101-000-1420-OCK) n21.3.44
PI'UN1Amc; rrvn . 101000-4;LO.400 $206.00
MING 1V1O"1'tON FE.Rx'521. -M '100-000-1241-00 . $28.63
/ ('3RA 1:tN0ti ` DT ,- 101-N1 -423-000
:tNPRAITHRU(MA)RE rf".sE225 900-443- 342 'sq.000.00
�
P*It1?.C151? p}.,1w 101-000-141=3
ARI' IN P1,IUIC'a`"1w;V ES - W11; 701-0004,55 000
. .SUJI- i`OFAL CONS WC"d' ON AND PLAN CHECK
W,462.26
L S Y:R1r=PA1U PEES :t ,
$0.00
!;OT AL A &.: RMI.TI V EES D V E NOW
$9.4624.6
JAN 2 2 1996 '
By
RECEIPT----
7Y'
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
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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
COMMENTS:
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 Liolice (Perm)
e r S�f3 � Y• ' f .
s CITY OF LA QUINTA -
• fro„�,� BUIL-DWG & SAFETY DEPARTMENT
r 'J 777-7012
io�CTION REQUEST. LINE `
777.7153 a
Owner T "RT DEVELOPMENT
.Contractor SPARKS CONSTRUCTION;
9601-087
Permit Number ' - j '
-POST. ON JOB IN CONSPICUOUS PLACE
INSPECTOR -_MUST SIGN,ALL APPLICABLE SPACES
'
JOB ADDRESS-- 9-06.0 VIAwSAN�CLARAA
SFD__:'LOT 19PLAN;1
72`L f
TYPE OF INSPECTION DATE INSP.
FOUNDATION '& SETBACK
j FOOTING STEEL
MAIN GROUND SYSTEM t
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN 1 NED
CONCRETE SLAB
JOISTS & GIRDERS'
ELECTRICAL GROUND WORK '
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & AS TESD 7/ a'g
HEATING & VEN C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ,❑ 4' ❑ 8'
FRAMING. -
INSULATION
PRE -ROOF n
COVER NO WORK UNTIL ABO .HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH lifiL.
POOL PRE PLASTER ,
ENCE & GATE
,6EWEj SEPTIC TANK
/.
FINALS,�,.
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING -'A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
I/95 TURN ON UTILITIES OR OCCUPY BUILDING
' Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot,Be Duplicated 619-7.75-3500 '
CERTIFICATE OF COMPLIANCE
Date 1/22/96 APN # 649-400-019 '
No.. 14070 Jurisdiction La Quinta.
Owner Name T.D. Desert Development Permit#
No. '79060 Street Via San Clara Log #
City 'La Quinta Zip '92253 Study Area 123
Tract # 27952-1 Lot # 19 Square -Footage 3465
Type of Development • Single Family Residence No. of Units 1
Comments
,:
At the present time, the Desert Sands Unified. School District does not collect Mees 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 Occupancy for
this square footage in this. proposed project may now be issued.
Fees Raid B p
Y T. D. Desert Development LTD +, Telephones 77149.41
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $5:,959.80
Check No. 7663/1486
Signature �04 'Al .PcIu 1 LILA AMYL
Collector: Attach a copy of county or city plan check application form to district copy for all wEivem
Embossed Original- Building Dept:/Applicant Copy - Applicant/Receim Copy - Accounting