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9601-079 (SFD)
LICENSED CONTRACTOR .DECLARATION: I hereby.&ehrm that I am licensed under provisions of Chapter 9 (commencing with S�ibn 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. 674074 B ��f��±,� � i License # �'. Lic. Class t" l.. p,. -Date \, Date 11,'7"''�•e'' Signatureof Contractor �1 OWNER -BUILDER DECLARATION , 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). ( ) 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 sectiQpIgdinyot�Y_9 completed if the permit valuatiop � ft§},90.00 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 afire, e stat if I should become subject to the workers' compensation, provisions of Sectior1,3700 of the�Lab • r Code, I shall forthwith comply with those onV. Date: /i V 6� Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation,, damages'as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application.. 1. Each person upon whose behalf this application is made & each person at . whose request and for whose benefit work is performed under or pursuant to any permit issued as a resultofithis appli , ation agrees to, & shall, indemnify & hold harmless the City of•IndidW6113, Its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatly f this City .to enter upon the above-mentioned property for ins on p rposesr . Signature '•(Owner/Agert /Date ! ' ""'10 BUILDING PEFMIT960.1-11179 •PERMIT DATE t1,17/% VALUATION VH6,2$S.SIs LOT 11 TRACT S 1 { JOB SITE ADDRESSAPN 79-1.05-VI'A SA CLAS 649.400-01.1 OWNER :CONTRACTOR SPARKS CON° 1 _ UC RON '.i�. t�. SF;tt I JJ:� V 1�C�.F i r.:[• �.' 101 WALft—,N BRIDGE' XD NO! P.O. BOX 1716 LA. QiJINTA CA 91253 LA CUtN`J.A CA 922.513 ( 119)771.1.94.1 t --`.I L.# 29yt5 (61`Y1714941 DESIGNER/ENGINEER P1"IKAREK-CRANDFELL. INC. 2M'r-A13IR1TC. FIER- DR. . ucc or P61+uT,1 NOIRE T'A1►i1,LY DWELLING T n:. -r .. n r :� s RANCHO LA QUIN1,A �_ _ _ _ PALAC.IO.PL•AN I FEE DESCRIPTION FEES CU-Tr0 S CONS'" rJ.ZVC',V1ON 1,465.01) Ll POTtCHJPAILO x.335..00 S!: GAtZA0F)CARPOR.T 608,00 S:t, OSTI ATED COSTO& CONSTRUO HOa1 286,295.50 PERMIT FEE SUMMARY PLAN CHECK VEH 101-000-4393 f3 S.t,e�s.95 CONI 1rVR.'UC1:aCN rf,��'!^�. 101-000.419-M S L 29 S 0 MECMANICAL FEC 01-000-421-000 $143.50 H:f.EC'MJC AL FEE 101 -0t}t?-4211• W $213.44 P.LU BINr FF -F 1.01-000-4:13-{100 $2i16.clf► STUNG MOTION rEE - •TtSPD 100.000241.4100 , S28.63 GRAMNO 101-000-423-000 $2t1,0U Miff iiA )=I�t1r:!'L'[1I2k� FEE 223-000-44-A-342 $s,ufKl:O© PRECISE PLAN AI -41110.441-344 ARAP 1N PUBLIC PLACES - RESM701.000-255-000 $465.74 " r y�-TOTAL C.�ONs-rkiJcnoN' ANQ PLS' GEI m 0 0 _ o LE PRE -PAID FEES V,462.26 $6.00 SAN 2 2 TAY,, P� IT FE D U�a>vYoW $9,462,26 1996 'j By RECEIPT DATE BY DATE RNALED INSPECTOR INSPECTION RECORD °0 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR r 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 I I 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. S. -.4e Detectors Temp. Use of Power t J 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# , r549-400-011 14062 No: Jurisdiction La Quinta Owner Name T.D. Desert Development Permit # No.. 79-105 Street Via San -Clara Lag# City La Quinta Zip 92253 Study Area 123 Tract # 27952-5 Lot # 11 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 addition's 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 t this square, footage in this;proposed project may now 'be+issued. x?i TT C , Fees Paid By T.D. Desert Development LTD ,Telephone -771 4 X-1941 Name on the checkLo By Dolores A. Ballesteros ;v x Superintendent Fee collected /exempted by Pauline Pearson Payment Received $5,959.80 ,y Check No. 7663, Signature l A , 0 ;'„ o P4 n�nAa A/ —. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Covv - Avplicant/Receiiit - Corn - Accounting T CITY OF LA QUINTA OF ;IbING & SAFETY DEPARTMENT %jt777-7012 �WW PEC;TION REQUEST LINE `� Gp 777-7153 i Owner T79 nFSF.RT TIF. .DEMENT I Contractor SPARKS CONSTRUCTION 9601-079' I Permit Number - POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES I JOB ADDRESS 79-105 VIA SAN CLARA f SFD OT 1 LAIC 1 I TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK = FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING - i PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB —/ JOISTS & GIRDERS ELECi7• .Ml. GROUND WORK { DO NOT POUR CONCRETE UM. L ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING i ROUGH GAS & GAS TEST HEATING & VENT A/C FIREPLACE .. ROOF BOND BEAM O.K. TO WRAP , GROUT O 4' O 8' ""FRAMING S i INSULATION PRE -ROOF COVER NO WORK UNTIL.ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL FENCE & GATE SEWER SEPTIC TANK FINALS ELECTRICAL PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO 1/95 TURN ON UTILITIES OR OCCUPY BUILDING