9601-084 (SFD)LICENSED CONTRACTOR DECLARATION. ,i�; "`-
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. 614074 8 7/31/ 77
License #' / Lic. Class,,-,— \ Exp. ate"`'O,
Date 177:TT / , SignatureofContractor -"�
OWNER -BUILDER DECLARATION r
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).
(a ) 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.
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.
(This sect otlfneedikot b•_'e completed if the permit valuadwJ;; Jfog$,4Q0.00 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 the—or
Code, I s all forthwith comply with those provision .
Date: /I -� -/f1, � 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 result of this application agrees to, & shall, indemnify
& hold harmless the City of ln&WQisflts 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 representativesofUii City to enter upon the
above-mentioned property for inspection p-°u�rposes.
Signature (Owner//gent) �. w f 1 f Data
ALC#
BUILDING.
PERMIT
PERM1601-0
I
DATE 1941
VALUATION Z J.-) .L.�iHU
LOT LO TRACT 17S.3iI.-➢ -
JOB SITE ADDRESS 79-4)90 VIA SAN CLARA,
APN 649.400-016
OWNER
CONTRACTOR
SPARKS C0N8'.1'R"t,JCM0N
TD. )ads,SERT DEVELOPMENT LP
101 WA.1.SrON'8KIDGE, RD NO,:
RG, BOX 1716
$' L.A QUIN-.1'A CA 92753 .
LA QUTNT.A CA 92253
# (01:►). 71-1941 C:BLL'# 21J6
(�.19iT� 1-I941
DESIGNERIENGINEER
PI~KAR'EK-CRANI IL,1Nt;:
236« BIRTC±HF.;TLDk v
USE OF PERwtAP4QLJS VANII L " UWW,tANU =
LAKE FORFs5T. CA 92610 C714)811-4 . .
til CHO LA'QUIN'I'A
PM,AC'TO PLAN 2.
FEE DESCRIPTION
FEES
(;tl'.s"1'OM CO;KS T'Rt1G'# JON 3,822.00 LF
PORCEf/.P.ATIO 180.00 SF
GAl2¢►.WCARPORT. R 666.00 SF
ESTIMATED COST F CO T ISTRUC TIOT4
313,181..40
MARS'
'.VER,IMIT FEESUMMARY
PL.A.N CHEC K FE'E 101-000-439_11i18 31,135.30
CONSTRUCTION FIM 101-000418-000 X2,38:3.50
_
NJEC5:Y LAICAL FEE 101.-000-421-600 8137.00
ff.E,CTRICAL FL76 101=000-4207-000 !8227,09
PLUMBING Fff, 101-000-419-000
S'170NO ngOT1014 FEC: - RESID 1,00--000-241-000 $31.32
ORADINTO F 101-00042.3-400 $20.00
INFKIVS1''RUCTUPLIE .Fft 225-000-413-3e12
PKECISE PLAN 101-000-441-345 S2S.f30
AR A` T -11;39LIC PLACES - REStic 701.000-2.55-000 $532.95
j
am --mm, CONMUC't'1UN AND PLAN CR CK
$9;703:_16
D q : LESS PRE -PAID r MS
'
$0.0040T
OTAL PERMIT FE" DUE NOW
2.2
$99703.16
1996
By
RECEIPT
DATE {
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
11 BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District ;
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE 'OF COMPLIANCE
Date 1/22/96 APN # 649-400-016
No. 14067 - Jurisdiction LaQuinta
OwnerName'T.D. Desert' Development Permit#
No. 79090 Street Via San Clara. Log #
City La Quinta Zip 92253 Study Area 123
Trach# 27952-1 Lot # 16, 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 squire 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:
�l ,
EXEMPTION NOT APPLICABLE
This certifies that. school facility fees'imposed pursuant to'. Government Code 53080
in the amount of 1.72 - X 3,822 or $6,573.84 -
the
6,573.84 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. h `
Fees Paid By T.D.- Desert Developoment LTD u=TeleOone: 6771 194.1
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received �$6,573.84-
Check
6,573.84-
Check No. 7663
Signature a-"J'/vu L `
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