9601-074 (SFD)LICENSED CONTRACTOR DECLARATION
LO I hereby affirm that I am licensed,under.provisioris of Chapter 9 (commencing with
_ W Section. 7000) of Division 3 of -the Business and Professionals Code, and my
:3 co License is in full force and effect. 6 74074 } .13 7/311/'-"l7
L License # w Lic. Class Exp. Dale 1 s
z Date //a 7:/ SignatureofC;,ontractor'
D H rn OWNER -BUILDER DECLARATION'
UWCID 1 hereby affirm that I am exempt from the Contractor's License Law for the
_CL
following reason:
U) () I, as owner of the property, or my employees with wages as their sole
Z 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
Cl) Date Signature of Owner
LO
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.
O 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.
(chis sectio'Thlh dK6trH'8 completed if the permit valuatidh'V060$:160.00 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 Seati3700 of the Labor
Code, I slhall forthwith comply with those provisiorhs.
Date: 1.! `t Applicant
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 resuk•of th scappli ftion agrees to, & shall, indemnify
& hold harmless the City of Indian-Weils; 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 aut oriie representative of this City to enter upon the
above-mentioned property for inspecton,purposes.
r
Signature (Owner/Agent) £ : wh+: > ,_ Date r� 7. f
err ,
ALCM
DING PERMIT
PERS► __�
.BUI
DATE haw
VALUATION LOT ' TRACT
JOB SITE ADDRESS
19 4055 VIA :,Al'4 6i'',ARA
APN 64."4184.006. l
.7
OWNER
CONTRACTOR
► .l'ARK:SCONti-12UC'd':1ON
T.D. DE RT3?t lrf 1,t}PW1 €d1 I..
14.! NVALST N BRIDGE RD NO.
P.O. BOX 1'71.6 7
LA QuiNrA CA 9225.) . .
LA L IJiNTA CA 9 r 3
(619)'7'7.1.1941. CBL_ # , 2996
(619)7714941
DESIGNER/ENG INFER
i'fhIC.ARt X=Cli.tlNnELL, INC.
23612 BIRTMIRDR. ,
USE OF PERMITfliV US...0 t"L'�fbi.l.l,. 1- L Y:,L".,4rL1l�l3
LAKE FOREST. CA 9.2630 (7:14)837-i
R.A14CH0 LA QUIN'.i'f1
PALAC10 PLAN 2
•.l
FEE DESCRIPTION
FEES
CUSTOM CON'SIRUCTK N 3,822,001
r
PORCIIHIPKf to f 180,00 ,;F
GARAGE/CARPORT 666.00 SF
PERMIT %'I:E SUMMARY {
�-
]PLAT CHECK FT i; 101-000-439-31A s l,, 1.15.;30
C0114SIRUCTION 1;W. 101-000-418-000
MJ;CFiA1 1CA1.FEE 101-000-4II-(}013 $137.11
M,.EC.I=RICAL 101-0530-420-000 $227.09
PLIL 4II3ING FEE 1,01-0,00419-00 419-(300 $206.00
1 fJA►i"s lliO rm x.1:'13; . .alp : 10000 241- ? .0 $31-42 . .
GRADR40 VE t01-400-423-000 $20.00
R4 .RA,3T1,;UJC I'Uf t'6 F88 225-000.443-342 $000.00
PR CSSF, pr AT<f 101-00U-4 :1.3 825.013
ART MT PUBLIC PLACE$ - IMSIC 701-000-" -000 $532.95
CC)NS'1 RU1CrY.QN AN'.11 PLAN 0-IECK
1.6
�Q� a LESS P1W_--RMD MES
DZY _N
$0.00
OTAL I°E:fftNIT. FEES DUE 1_VdJW
JAN 22 1996 -
$9,703.16 .
By
RECEIPT
DATE
BY
DATE RNALED
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
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.
-?moke Detectors
Temp. Use of Power
7
Final
Utility Notice (Perm)
COMMENTS:
F
Desert Sands Unified School District
Notice... 82-879 Highway Ill
Indio, CA.92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date . 1/22/96 APN # 649-400-006
No. 14057Jurisdiction La Qum a'
Owner Name T.D. DesertDevelopment Pemit # `
No. 79055 Street Via San Clara Log #
Y
City La Quinta Zip 92253 Study Area 123 ,
Tract # 27952-1 Lot# 6 Square Footage 3822
Type of Development Single Family Residence 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 Codr: 53080 `
in the amount of 1.72 X 3,822 or $6,573.84
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in.*this proposed•pioject may now be issued. _
Fees Paid By T.D. Desert Development LTD Telephone ;771-1941
Name on the check;' �.
ti14L
By Dolores A. 'Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $6;573.84
Check No. 7663
Signature PA ..j I AA, o mx AA -6/y -
Collector; Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building'Dem./Applicant Copy - AvWicant/Receim Com - Accounting
_ s CITY OF LA QUINTA
` a - ,BUIILLDIINW, AFETY DEPARTMENT
Vr
777-7012
01
! 21re�lON REQUEST LINE
JAN 11 777-7153
i Owner T.RANSTERVIIIEVELOPMENT
Contractor
SPARKS CONSTRUCTION
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
N
JOB ADDRESS ACLARA
SFD -L-OT-6i PLAN 2
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
HEATING & VENT -A/C
FIREPLACE
ROOF _ 3
BOND BEAM
"O.K. TO WRAP
GROUT ❑ 4' ❑ B'
FRAMING
n INSULATION C
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL v
PLUMBING
Fl AL GAS TEST
HOTI NG - A/C
HOUSE NUMBERS
JO.6 COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
ioc TURN ON UTILITIES OR OCCUPY BUILDING