9601-081 (SFD)w LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Sef?tion 7000) of Division 3 of the Business and Professionals Code, and my
Lich se is in full force and effect. 6,740,74 -8 71331��{'(
License #, ! _ Lic. Class ,Date` ,
,,.
Date ds'fi"' SignatureofContractor r ;r,G;''�� rt p I
A.
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).
O 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 ofthework for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This sectLoppngedtnoi�lpe completed if the permit valuatigVjp J9�P,Q0.00 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- action 3700=ofNthe Labor
Code,1 shall forthwith comply with thoseLprovisions.
Date: 9e 77— .Applicant r:. •/ 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
'I whose request and for whose benefit work is performed under or pursuant to
` any permit issued as a result' of tfiis application agrees to, &shall, indemnify -
& hold harmles`s.the City of Indian••Welts, its officers, agents and employees.
i,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 properr-inspecti.purposes_-;
• r
Signature (Owner/Agent)'" Datel I + _Z,�y
r
ALCM
BUILDING .PERMIT
PERMITar
DATE 1 . /t9b
VALUATIONi .J! .-1i
LOT 1
TRACT
JOB SITE ADDRESS 794 0 VIA SAN CLARA,
APN as 49-41D(a da1:8
OWNER
CONTRACTOR
P. AKS CONS"Lr f fON
-r i� niatr� am r�P�rr^j.it'I�a,1 �j'r r
' �.. !-/v 1,1, .y1l,i t! (./, ., � 4. ✓/. I,Y. 4.:,; 1. Lit'
+'", trALS"ON'BDa" v—Ta _
P .0..s3OX" 1716
LA Q JiWI A C_ A 92253 .
L.AOPIN°1A C.A. 0253
x (61.9)771-1941 C13L# .7996
(619)771-1941
DESIGNER/ENGINEER
23G7a 13IRTC HIMFDR.-
USE OF PERAAITjTN`d iI,,G' 1�1�►1t91:L`i _l7tiA' Z LIiVG
65.1
7 Wii4! I !: 1 a C714)Q1
1 tlNCHO .L11QLfNI'A
PALAC10 PLAN 2
FEE DESCRIPTION
FEES
Cl:lS'FOM CONy.I':RUC H N 3,8"=0011.
PORCWPAi'I() 180,00 SF
GARAGFJCARPOWf t 666.00 SF
:4
ESTIMATED COST PF CONSTRUf"'ff'IC` N
313.191.46 .
PERMIT FEE SUMMARY
PLAN CHECK FFF 1014M439;-3-118
CONS7'RUCi'TU:id 1; EC 101-000-418-()00 $1;3t3tf,$ti
'Ibf'riamNTCAAL rw 5137,00
S ECTRICAL FEE 1.01-000-420-000 $227.09
PT-UPABINO FEE 101 -000419-000. $206,00
S:l"QNC .MO'.1 i0N I;?$C; - RE, SID 100-000-211-000 $31.3 '
0RAEDING HE .1,01-000-423-000 120.00
25-W(1-x•13-342
ZNF'RAS'1RttCTURF'F" 225 -W"43 -342 -
Pg ECfSE, PLAN 101-000-441-345. $2S r30
PRE C f SE,
ART W PUBLIC .PLACES - RESM 701-1)00=255-01,0
.-TOTAL CONMUCTION AND PLAN C
AN r�;RECTiK �
-LESS P..PM-PAID g'.j3FS
$9,700�3.�16
.01?
'.GAL PERMI FEES DUE NOW'
JAN 2
$9,703.16
. 2 ,996
By
[RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
g M�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 Wali 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
OX 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:
C _ OF-L�,AiQUINTA ,r
tk �x�t �r i
,.Of G &`SAFETY DEPARTMENT
,*rr�` em•+�I�
SPEC ION REQUEST LINE z,
7777153
Owner T.D: DESERT DF.VF I:OPMTNT
SPARKS CONSTRUCTION "
• Contractor '
Permit Number 9601-081,
v.
POST ON JOB IN CONSPICUOUS PLACE
INSP€CTOR;MUST SIGN-ALCAPP_L_ICABLE SPACES
79-120 VIA SAN CLARA
JOB ADDRESS
SFD LOT 13 PLAN 2� ;
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL L
MAIN GROUND SYSTEM
—GROUND PLUMBING .9-73
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE 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 - 1
BOND BEAM
O.K. TO WRAP -
GROUT ❑ 4' 0•8'
FRAMING
,—INSULATION i
PRE-ROOF
E -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED,
DRYWALL INTERIOR
EXTERIOR LATH i
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
r=
N ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING
Desert Sands Unified School District
Notice: 81479. Highway 111
Indi, CA 92201
Document Cannot -Be Duplicated -
.619 -775-3500..
.
CERTIFICATE OF COMPLIANCE
Date 1/22"/96 ' " APN # 649-400-013
No. 14064 Jurisdiction LaQuinta€
Owner Name T.D. Deseret Development Permit # r
No. 79120 Street Via San Clara Lag #
City La Quinta - Zip 92253 Study Area- 123
Tract # 27952=1 Lot # 13 Square Footage 3822
Type of Development ' Single Family Residence . " - No. of Units 1
Comments
•p e
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:
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 property listed above and that building -permits and/or Certificates of Occupancy for
1 �
this square footage in this proposedproject may now be issued.
- ks `4i_' .•1 .W 1.
Fees Paid B T.D. Desert Develo oment LTD ' Telepl3onE .771-1941
Name on the check
By Dolores A. Ballesteros .{
Superintendent "
Fee collected /exempted by -Pauline Pearson Payment Received $6573.84
Check No. 7663
Signature Q 1, /yA Pj kl),A o Zrvq
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/Receivt Covv Accounting
4
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:
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 property listed above and that building -permits and/or Certificates of Occupancy for
1 �
this square footage in this proposedproject may now be issued.
- ks `4i_' .•1 .W 1.
Fees Paid B T.D. Desert Develo oment LTD ' Telepl3onE .771-1941
Name on the check
By Dolores A. Ballesteros .{
Superintendent "
Fee collected /exempted by -Pauline Pearson Payment Received $6573.84
Check No. 7663
Signature Q 1, /yA Pj kl),A o Zrvq
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/Receivt Covv Accounting
a
C¢rfificai¢of Occupancy
City of la Quinla,
Building and Safely Deparlmeni,
This Certificate issued pusuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating, building construction or use. For the following:
BUILDING ADDRESS: 79 -1,20. -VIA SAN CLARA
Use Classification: SINGLE FAMILY DWELLING Bldg.,Permit No.: 9601-081
Group: R3 Type. Construction: VN Use Zone: RL .
Owner of Building: T.D. DESERT DEVELOPMENT Address: 79-120 VIA SAN CLARA
City: LA QU,INTA, CA 92253 _
By: KIRK KIRKLAND
Date: 10-22-96
Building Official
POST IN A CONSPICUOUS PLACE