9601-032 (AR)c!1 'LICENSED CONTRACTOR DECLARATION
N1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
.- LLI Section 7000) of Division 3 of the Business and Professionals Code, and my,
o O Lo License is in full force and effect. 614074 B 7/31/95
n W n License # Lic. Class _ .;,Exp:' Date
r` Dateg V SignatureofContractori":_,.%'
CD OWNER -BUILDER DECLARATION
J WCID
I hereby affirm that I am exempt from the Contractor's License Law for the
a. following reason:
Z ( ) 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).
( ) 1, 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
ul Date Signature of Owner
N
Orn
U WORKER'S COMPENSATION DECLARATION
a Q I hereby affirm under penalty of perjury one of the following declarations:
o 2 Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
LO �< O compensation, as provided for by Section 3700 of the Labor Code, for the
X w LI- performance of the work for which this permit is issued.
Q J J () I have and will maintain workers' compensation insurance, as required by
m Q U Section 3700 of the Labor Code, for the performance of the work for which this
O U permit is issued. My workers' compensation insurance carrier & policy no. are:
LO
Carrier Policy No.
Z (This sectj9p,9"dlTJ,11, 9 completed if the permit valuatiop:js f99$J 40.00 or less).
r- =) .4
1 certify that in the performance of the work for which this permit is issued,
QC3 I shall not employ any person in any manner so as to become subject to the
-1 workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions' `Waction 3700 of the Labor
Code, I shall forthwith comply with;tho es provisions.
Dater -4 ?C Applicant-_`
1
r ''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 Wells, 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
kcorrect. 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 property for inspectiio", rpn es s.
;Signature (Owner/Agent! Date -z-&
ALC0
--BUILDING PERMIT
PERMIT`164la_032
DATE 21 119Y119YU
VALUATION 1�4'0,4J -X LOT
TRACT
JOB SITE ADDRESS � , �
APN e76�760_010 '
OWNER
CONTRACTOR
SPARKS CONSTR fJ6TION
I.C;I*I CIIT N't , .
103 WAIMON MDGE RD NO,
79100 BRiARWOOD
LA QL.�ii I'A CA 92:53
LA Qt. imm C.il 92253
(619;)77.1-1941 C B[1# 2996
DESIGNERIENGINEER
USE OF PERNIA ., i LU
(4(,A N't` k4Utf81,i A "guest ujW. wldch dow nuI'h1 vc cooking grls .tifm but fuss
slegpt ng and sanitary f ililies..1.CEMC 9.44320
FEE DESCRIPTION
FEES
f:iJSTO.M CON�:i"i�L;G;'i`40N 51.9.09
I
.,�7�.0 .ILL,�EA•I .PJAI l.�1JL OJ.I' 6.�/i�4D ieV 6.•A.niY,il�
�[� �jf/j $e�
'Y'0,430,10
!r ER:NOT I; UE STIMMARV '
P(,AN f','1`4f 0K :Fb:P 101-W-4310-319
CONS'I1RUC ILON FEE 101-040-4118-000
�
1'+<fivCHANICAL FFM 10 -OW-421--000 .S3 .50
'-- T
1311-iCTRICAL IFFE 103-000-420.000 $40.67
CO
M
ay(:C1WRYNCTTITF,
cn
Sq(?NC3'1c1'Tko7 ., T":1"s - 32V)ID .101-000-: r41_-000 $..t1,
00
INFRA8TRUC d Ll;ktl l UE, 225-000-443-342
a m
LJ.1
LL-
SUS -TOTAL CON91'Rii['C` ON P,.ND PLAN CHECK
$Ifi9l,97
LE PR.F PAID FEES
$0.00
TOTAL PERMIT .I+ ES DUE NOW
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
1
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
COMMENTS:
t [[
�s
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)