9601-085 (SFD)LICENSED CONTRACTOR DECLARATION _.
I hereby affirm.that I am licensed under provisions of Chapter 9 (commencing with
,ySection 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect. 674074 B 7l31.1 q
License #/ /' Lic. Class .,, Exp: Date.
Date ' �, Signatureof Contractor ef
OWNER -BUILDER DECLARATIO
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).
( ) I am exempt under Section , B&P.C. for this reason
Date Signatureof 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 sectiipn/neecltnot\pe completed if the permit valuatioh`i9166$t00.00 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-37Wof the Labor
Code, I shall' forthwith comply with those provisl n ,r
Date: i l ' A� Applicant s' ' .
�.
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 application agrees to, & shall, indemnify
& hold, harmless the City of1ndiQ0ell"i 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.
ALC8 BUILDING PERMIT PERMIT ;
DATE xr i. it _e VALUATION ww •tui LOT i r TRACT a• l E-' i�,
JOB SITE ADDRESS 79-0180 VIA SAN CLARA APN 64.99 44i4 -11I'7-
OWNER CONTRACTOR {
Si}Al2x.s COI�IS`!'R.Ut'..�i(JAI
T,D. s)ESERT Tal?LJ'FLOPMENT LP 101 WALSTON BP, IDGE RD NO.
11.0.90X 1716 LA QU19I'tt CA. 922.53
LX QU1NTA. CA 92253 (619)771-1941. CBL,.# 2996
(6.19)"!714941 DESIGNER/EN NEER
i' Yf rs" li'115_CRANDF11.1,, INC.
t,
USE OF PERMIPe.1*4%JJ-sr^JVJI9I trvps.�.3.`tivsa asvreouc,�tige s�,nra�.
1 ag=. CA 92 0 f714)937,! .
t%'MCHOLA QUJ:NTA"
PALAC70 t'. AN 1
FEE DESCRIPTION FEES
CUSTOM CON'SITRUG11ON' 3,465.00 L J
PORCN/1'+A.TiO 335.00 SF "
GARAGWCA1t1 Xr 608,00 SF
lie
ESTIA" T ED COST OF CONSTRUCTION
PERMIT FEE SUMMARY
PLAN CHECJ..FE11
101-00C,439-3i.R
CONSTRUC x iON SIM
1.01-000-418.000
$1,294.00
MECtIANTCA3 f1X
• 101-000-421.-000
S-143.50
OX.C'1'RICAL FEE
101-000-42.0.000
$21:3.44
FL1Iti»�Ttaty 1 a
1,01-00()419-000
$2f1r..Ot)
S"d'Ci'NG MO'.S't.GN rtF - RESSIO
100•-000-241'-000
S203.63
C't1iADI..NG . lErl'
101-000423-000
i:N1-'RAATO2t IGTURE AW
225-000-443-362
$6.600.00
jMtic1ISE PLAN
441-345
101-M-441-345
AR1' 1,3LQ3L1C PLACES - RE 701-01;0-255-000
546534
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 pu poses.
,-
SigneMre (Owner)Agent)i i % Date >17 %. RECEIPT
•Tu A �
'SUB -TOTAL CO NSTRUC CION tWD PLAN' CHECK
LOSS Pi E-PATD PEES
TO. PERAW" EES DUE NOW
�i
J,1.N 2
By
DATE _ eV DATE FINALED II
$9,462..26
$0.00
59,462.:26
z, INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
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 Pibg. 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
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 Notice (Perm)
Desert Sands Unified School District T
Notice• 82-879 Highway 111
• Indio, CA 92201 -
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 1/22/96 APN # :649-400-017
No. 14068 Jurisdiction La Quinta
Owner Name T. D. Desert Development Permit #
No. .79080 Street Via San Clara Lag #
City La Quinta, Zip 922"53 Study Area 123
- 1 ,
Tract # 27952-1 Lot # 17 Square Footage 3465
Type of Development, Single Family Residence` .No. of Units 1
Comments +
}
F 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 Occupancy for
thiss uare foota a in this proposed ro•ect may now be issued. �`�• "�'-'''` i�r,_. t�
q g p p p J Y
Fees Paid By T.D.. Desert Development LTD �Telephojae ,:7`71-194-1i"
Name on the check T �
By Dolores A. 'Ballesteros ' '�
"`�.
Superintendent
Fee'coliected /exempted by Pauline Pearson Payment Received $5;959.80
(� (� Check No. ' 7663
Signature �"Otu�onnD �i &AA
Collector: Attach a copy of county or city plan check application form to district copy for alfwa--vers.
Embossed'Original-.Building Devt./Applicant Copv - Atiplicant/Receipt Copy -Accounting
s _ CITY OF LA QUINTA
s� BI�IWING & SAFETY DEPARTMENT
°r
of
777-7012
9CYSPECTION REQUEST LINE
777-7t53
Owner `, D ,DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9601-085
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-080 VIA SAN CLARA
SFD Z OT�17 PIAN 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 S NED
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
O.K. TO WRAP L ..
GROUT ❑ 4' ❑ 8'
FRAMING -
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
- -FINA
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOS' G.IAPLETED
T POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1195 TURN ON UTILITIES OR OCCUPY BUILDING