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9601-077 (SFD)
LICENSED CONTRACTOR DECLARATION '+ mre '6ffirm 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. 671,074 B 7131/69/ License #,.- 1 Lic. Class ; e Exp`."Date "-';. Date 1f7-7 tr f- Signatureof Contractor OWNER -BUILDER DECLARATI&N 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 the16-otdodN, &M eiiclusively contracting with licensed contractors to construct 1he;project (Sec. 7044, Business & Professionals Code). O I am exempt under Section B&P.C. for this reason Date IsignatureofOwner 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. M_ y workers' compensation insurance carrier & policy no. are: Carrier Policy No. (This sectio uW.dliiot be completed if the permit valuatiotfji ,for),$400.00 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 fortliwith comply with those provisjorns Date: I`9 'frF Applicant ` i� 4 Warning: Failure to secure Workers' Compensation coverage is unlawful and shell subject an employer to. criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work'is performed under or pursuant to any permit issued as a result' ofrth syapplioation agrees to, & shall, indemnify & hold harmless the.City of lndie�n•Mlis, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation.' I certify that I have, read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorise repressves of this City to enter upon the, above-mentioned property •for in$pection urposes. Signature (Owner/A9er Dat, ALC i BUILDING PERMIT PERMITi ,. ¢ . ,, DATE 11 1. 190 VALUATION LOT a' TRACT 1' 1. r� JOB SITE ADDRESS *79-085VIA $AIN CLARYX API 649-•400-009 OWNER 'CONTRACTOR SPARKS Cc I STR1JCf'Tr N °!'.D: DESUR T! }�:�!;:10Y..MENT LP 0l.11rF`.LS'YY7 a� g3RIT)G:1: RD NC). P.O.13OX 1716 t.A QuiNTA CA 92253 LAQLT#1�tft1 c 1k 422.53 t (r�19j7�:t�P��% i",t�L� 1996 (619)771-1944 DESIGNERlENGINEER P K.APE'K-CRAtr+13 A., INC.. �3v+ SIRTCs'iFaiDR.- uocorrcnMlio.rw',�ovt; � .� t.Is��,.r' LAiaR 70117RA f 92F"tfi (7141917-1 -RANCF10 LA Qii1NrA PALAC10 PLAN .i 3 FEE DESCRIPTION FEES CtJYr0iv1 CON,*TVRUC#'t©'N 3,465.00 LF Y•tOtCRIPA,n.0 l 31_45,00 SF GARAGFJl 'ARPORT '' 608.00 SF .t FSTIMATE D COST OFCONSTRUCTION ION 286395.80 . PERMIT 1F1'f.E SiPJ)lPiM.ARY PT, AN CNE CK FE 101.-000-439-318 S1,065,95 C0Ns.rRUCT1QN FEE 101.000-418-0.00 5i,29t.(tt) MECHANICAL FIM' 1.01-000-421 $143.50 ELEC 7R1CAL FEE 103-000-420-M! $413.44 PLUMBINO fT-E 101 -M0419 -ow W15.00 ST ONG MOTION FEE - RESXI) 100-000-.,,-11-000' 328.53- Oi2ADING FL1 i0j-000-423-M $20.0 TINT AS1RUCTU RE FEE 12.5-000-443.342 %,000.0 PRECISE -PLAN $2.5.00 ART IN PUBLIC PLAAC".ES-`.JMS11C 701-000-255-000 $465.74 j , 31IS-TO.iAL CONS -I WICT1ON A,ND PLAN CHECK ?LESS PRE -PAID FEES PERMIT FEES DUE NOW . 90A $9,462.26 AN 2 � 1 996 V Y RECEIP DA• BY, DATE RNALED INSPECTOR INSPECTION RECORD f1J OPERATION DATE INSPECTOR BUILDING APPROVALS OPERATION DATE INSPECTOR 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 BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . 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 Piaster Sewer Lateral Pool Cover .3ewer 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 r Final IJ�Q,y Notice (Perm) COMMENTS: t Desert Sands Unified School District Notice: 82-879 Highway 1.11 " Indio, CA'92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date, 1/22/96 APN #' 749-400=009 No. 14060 Jurisdiction La Quinta Owner Name T.D. Desert Development Permit # No. 79085. Street . Via San Clara Log # City La Quinta Zip 92253 Study Area 123 Tract# 24952-1 Lot # 9 : 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 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: ., t 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 Paid By T.D. Desert Development LTD 'Telephone's 771=1.941 Name on the check , r4"` F moi• o By -Dolores A. B'allesteros Superintendent •g�f+�.A plc.. • , Fee collected /exempted by Pauline Pearson Payment Received $5,959.80 Check No: 7663 Signature' A I A p 3 n," o 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 Copv - Accounting s �1, a s _ CITY OF LA QUINTA 1 13 ggg&& SAFETY DEPARTMENT psi 777-7012 C.t .N�CTION REQUEST LINE �, �N v 777-7153 Owner T.D?6 SERT DEVELOPMENT Contractor SPARKS CONSTRUCTION 9601-077 Permit Number POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES 79-085 VIA SAN CLARA JOB ADDRESS SFfDr;:. LOT 9PLAST. 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 aONCRETE 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 I ` r►O.K. TO WRAP 9(�. ( -9' GROUT ❑ W 0 8' -FRAMING INSULATION PRE -ROOF COVER NO WORK UNTIL ABOV HAS BEEN SIGN DRYWALL INTERIOR !i e 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 i