9601-080 (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, and my
License is in full force and effect. 674074j3 e^` '�/3` )�R,6z`l
License #f 1F Lia Classl -ate j
Date!/7' el. (4 SignatureofContractor r'
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 oT ine proporty, am dkdIuslvely 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 secti0_pjkig djrt. a completed if the permit valuatiopjs �o $ 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 agree that if I should become
subject to the workers' compensationYprovlsions of Section 3700 of,th'e Labor
Code, I shall forthwith comply with tHosefp ovisi1s. ✓''
Date: °. "V VApplicant ;.....
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian-INeltt, Its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit t6 cancellation.
I Certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
r
above-mentioned property for inspection purposes..'. a
Signahue (Owner/Agent) Date? < r
A"'
BUILDING PERMIT
PERMIT�(�I-t)'�ly
DATE 1111196
VALUATION 3 J,t51.4#J LOT .ti
TRACT s.tYYz.-l.
k
JOB SITE ADDRESS-�:$;� VIA2 .3' $.Ai e�
API 649_X60"iZ.
OWNER
-CONTRACTOR
,PARKS CONS - [AMON
�t;'T?1nl
L ,1J.. . �. !� a � 1. sat.
/
!r,\ Y t'Ai 'fYlr"i'; n J`Arf'1
1),0.88x. I"Ij.6
f LA LQUINTA. CA 9223.3.
LA.QUI N'V CA 92253
F (619)771:-1.941 0131.,# 2996
6j9)x!.1` j.941
DES16NER/ENGINEER
P)+,l�:.A9r1K-CRAN1)E1<L,1N1C,
736 —,Z81R'C RDR,.
uccorrrnmt.;1,1,PC;J, ' A' llV .1LY ll YL jU1f4'(;
1tANCH.O .LSA QUJ'N'1'A.
PALACIO :PLAN 2
FEE DESCRIPTION
FEES
CUS'1't;11t2 CONSYRUC` ION 3,0=1,00 LF
PokcNIPA.`rlo 180.00 Sr
GAL(AWCt\12P< W17 60.00 S1:
ES T)A IAT'Ej0 COST OF CONSTRUCTION
313,181.41)
PERMIT FEE SUlaMILARY
J?I.AN 01CCK 101-040-439.3tg $1.,; 11i'V
COr7STRUCTION F`EJr IOd-00U-41$�0� $ t,3ss.s0
NWICHANIC'Ai l:'EE 101-400-421-000 si37.00
J EC MJCAL .FER, J 01-000-420-000, $227.09
PJ IJM-BI.N0'F .1.01-000-41.9=000 $206.00
STONO IMOTXM, FEE - 2E,31D 100-000-241-000 33.132
GRADIN'C rEE 101-000423-000 $120.00
FNFRA,SfRTJC'1'f, R9FFE 225-000-443-34.2
PRECIV- Pr AN $215.09
ARTIN PUBLIC PLACES - SIL: 701.-000-2.55-000 SS3^a.�lS
St T -TOTA.L. CONSTRUMIC)'N ANIS PLAN CHECK
$9,103,16
LESS -PAIL) FEV'S
F)
$0.00 .
D
, PERMIT F&f,D,S DUE NOW
$9,703.16
JQ N 2' 2PRE
t?s
1996
RECEIPT
DATE
BV
DATE FlNALED
INSPECTOR
ros:,
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
E?ctedor 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 Plbg. Test
Final 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
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)
VTY•OF LA QUINTA
:w ' o, ~ s� BUILDl1d'� SAFETY•DEPARTMENT
`�c�c�� 777-7012 `
_ �1qN, ION REQUEST LINE.
` � � • " ' � �`-.<.,.: "777-7153' . •
• _ ,, ,fit• � r . • �, i
• ,;
Owner. T.D.,DESERT DEVFLOPMENT
N
# " SPARKS CONSTRUCTIO,
4.
Contractor
9601-080 • ..
Permit Number,
POST ON JOB IN CONSPICUOUSPLACE
r�. INSPECTOR MUST SIGN ALL APPLICABLE SPACES
_ '79-115 VIA'SAN CLARA
r JOB ADDRESS
}' r" SFD LOT-12,.:�PI;AT72`
,,. TYPE OF INSPECTION DATE INSP.
} FOUNDATION & SETBACK r'
FOOTING STEEL `
• �p " MAIN GROUND SYSTEM
r _ - GROUND PLUMBING `' ; 0.
- , 1�',• PRE-GUNITE r ,
DO NOT POUR CONCRETE UNTIL ALL- ABOVE HAS'BEEN SIGNED
#. , • CONCRETE SLAB
= i JOISTS & GIRDERS
ELECTRICALGROUND WORK
y DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED''
ROUGH ELECTRIC Jr
ROUGH PLUMBING s -
A ROUGH GAS & GAS TEST
• �� 4S HEATING&VENT - A/C
r nt
FIREPLACE
' --ROOF
t _ s BOND BEAM
`w ^, O.K. TO WRAP
J / �•
• • GROUT ' ❑ 4' 3 ❑ 8'
a FRAMING
`
—INSULATION
PRE-ROOF ,
yr COVER NO•WORK UNTILABOVE HAS BEEN SIGNED -
DRYWALL` INTERIOR.. 7
F EXTERIOR LATH; 6
_ y
POOL PRE PLASTER ,`•
POOL FENCE & GATE -
;SEWER SEPTIC TANK
FINALS•'"x`
' ELECTRICAL
PLUMBING•
tl + r FINAL_GAS TES7F"
} HEATING - A/C. ,` ." `•.1.
HOUSE NUMBERS'
' JOB COMPLETED
' 'TEMP POWER
r ABOVE APPROVALS DO NOT INCLUDE -RIGHT TO
' ` TURN ON UTILITIES OR OCCUPY BUILDING
Desert Sands Unified School District
Notice: . '82-879 Highway 111 '
Document Cannot Be Duplicated Indio, 5 92201
619-7775-3500
CERTIFICATE OF COMPLIANCE
Date 1/22/96 APN # 649-400-012
No. 14063 Jurisdiction La Quinta.
Owner Name T.D. Desert Development Permit #
No. 7911-5 . Street Via San Clara Log .#
City La Quinta Zip 92253 Study Area 123
Tract # 27952-1 Lot # 12 Square Footage 3822
Type of Development Single Family Residence No. of Units 1
Comments
At the present' time, the Desert Sands Unified School District doesnot collect. fees on
garages/carports, covered patios/walkways, residential additions under 500' square feet, detached
accessory istructures or replacement mobilehomes. It has been determinedthe 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 unposed -pursuant to Code 53080 •
in the amount of 1.72 X 3,822 or $6,573.84 -
- the property listed above and that building permits and/or Certificates of Occupancy for
• a µ -
this:square footage in this proposed project may now be issued. - t
Fee's Paid By T.D. Desert Development LTD Telephone `.771-1941 r
4 G
-Name on the check y a ^'
By' Dolores A. Ballesteros ,
'Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $6,573.84
° Check No. '7663
Signature PLZ_ a .;L_o P 0 AAA Ja ?V1, r
Collector:' Attach a copy of county or city plan,check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Avvlicant/Receipt Copv - Accounting
°