9601-083 (SFD)LICENSED CONTRACTOR DECLARATION
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, anis my
License is In full force and effect. 6740.74 li 7/3)1'"r1�
License #f / Lic. Class r`"" t Exp/Date's '
Date 1.17z'1;?1Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that I. am exempt, from the Contractor's License Law for the
following reason: l
( ) 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 sectjo6,#"cth9hbe completed if the permit valuation_is,Jg9$4.W.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-provisionsf•-Secti6n 3700 of the Labor
77
Code, I shall forthwith comply:with those provisioirpps. -^'—
Date: r% % Z'` Applicant 1r "I••
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 resuhlof this appl' on agrees to, & shall, indemnify
& hold harmless the City of InchVWells, 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 authorize representatives of this City to enter upon the
above-mentioned propertyffor•-inspection purpn
SignalLre (Owner/Agent) �S /� t D4
G'e.:t���r^✓'1d�7 %..ley .7•''f,J(i'f,,1�t
BUILDING PERMIT
PERMIT�i Oi-
r
r-
DATE ill. 11YO
VALUATION
OT .:a
TRACT 4 1 J -J.
JOB SITE ADDRESS 79-100 VIA SAN CLARA
NA
4649-40�6`�
OWNER
CONTRACTOR c
SPARKS CONM,UCTI N,
T.D. DEStU DEVELOPMENT LP
101 WALST0—N ] RfL 0E 11U) N0
P.O. F3QZ i716LA:t
UINTA CA9i2S
1,AQUfNTA CA. 92.253
.
(6:19)%71-1941 CBI.,# 2996
(6.19,4771-.1+1d1.
DESIGNER/ENGINEER
PEK11FRE-CRA.NDEGL, INC.'
2X71D1RT1 DR .
USE Of PERW—O ,I q ULEX 1' N ') - f OWLIULANU
LAK% FQRFS • CA"9'xV. 0141§37-4
ItA1dr~HO LAQU Tf..I'A
PALACIO PLAN I
FEE DESCRIPTION
FEES
CU8'1'G C0NS 1R.t,tt•`"i f0N 3,465.001.'
`
P0IZ,CH/P:AT10 335.00 51
GARAWCARPORT 608,00 5F
t
ESTIMATED COST OF CON rRUCTIOtN
286,i9530 -
PERMIT FEE SUMMARY
PLAN CI_ xU 101,,000-4397318 S3,06s.�5
CONSTRUCTION FEE
IECHANICAL P;tX 1011-000-421;-.1 06 $1,43.50
ELECTRSCAL FTE - 101-000-4207-000 $2113.41
P11"ING Fh'G .101-000-41941t?0
STONG r%10 "ION VE6 - RESID 100.000-241-000 $21x.63
ORADING ME 1.01-000-423>G00$2x.00
I .P-46'1 RUC'CUItE IT -_-F, 225-000-443-342 $E WO.00
PI t1 fC13 :PL!%`.N 101-00 7-441-34§ . 25,Uc�
ART IN Pitt LIC PLACES - Rmp 701-000-255-000 $465.74 .
F
'F SUB•1VrAL CONSTRUC .TION AND PLAN C)4-RIK.
$9,462.26
DESS :PRE. -PAID FEES
$0.00
n
TAL.)PERM11'FE S J•�1E NOW
Sg,4 62.26
fJAN 2 2 1996
RECEIPT
DATE ��"
BV
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
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 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:
�'Ile
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/§6APN # 4549-400-015
No. 14066 Jurisdiction La Quinta
Owner Name TD: Desert Development Permit # ;
No. 79100 Street Via San Clara Log #
City La Quinta Zip 92253 Study Area .123
Tract # 27952-1 ' ' Lot # 15 �` Square Footage 3465
Type of Development Single Family Residence - No. of Units 1
Comments
r •
` At • the present time, 'the Desert -'Sands ` Unified School District does not collect fees on
garages/carports, covered patios/walkways, residential additions under500 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 followingreason:
r _
' EXEMPTION, NOT APPLICABLE
'This certifies that school facility fees imposed pursuant to Government Codi 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 his.proposed projectmay now.be issued.
Fees Paid,By T.D. Desert Development LTD -'Telephone 771 1.:941
Name on the check
By Dolores'A: Ballesteros j
Superintendent
Fee collected/ezemptea by Pauline Pearson Payment Received' .` N-15 ia59.80 W
Check No, 7663
Signature �� . fin► a ��u..� ,
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building-Dept./Applicant Coov - Applicant/Receipt Copv - Accounting