9602-015 (SFD)U)• LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
o Cy M License is in full force and effect. '
n w r License'# i ° :. ; U6 E��s7z El Exp. Date � s1i}�
r^. Z r Date (o • ignatureofContractor�� �'
a e r
crp � 0) ( s r OWNER -BUILDER DECLARATION d +
JIU I hereby affirm that I am exempt from the Contractor's License Law for the
f—CL
following reason: �t
U) () I, as owner of the property, or my employees with wages as their sole
Z 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
Cl) Date Signature of Owner
LO
04
t 0 0) WORKER'S COMPENSATION DECLARATION
aQ I hereby affirm under penalty of perjury one of the following declarations:
o Z () I have and will maintain a certificate of consent to self -insure for workers'
LO r HOS Cc compensation, as provided for by Section 3700 of the Labor Code, for the
X W — performance of the work for which this permit is issued.
p J J ( ) I have and will maintain workers' compensation insurance, as required by
00 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:
rn IQ— Carrier -.,Policy No.
Z "' (This section need not be completed if he permit valuation is for $100.00 or less).
n a" Ir ( ) I ceriio at11A1tthV performance of the work for whibK4tk59VA1mlt is issued,
Cl I shall not employ any person in any manner so as to become subject to the
\5 workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section -3700.. of the Labor
0 Code, I sha)I forthwith comply with those provisions '
Date: Z. I 1 16 . Applicant
c. 2 1
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. L
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 buildingE
construction, and hereby authorize representatives of this City to enter upon the
• above-mentioned property for inspection pur 0906."
Signature (Owner/Agent) '! f \ { Date �, f
A"'
BUILDING PERMIT �
PERMITr
4rffz-11>I�
DATE 21,
VALUATION $21;514.30 LOT
TRACT
JOB SITE ADDRESS 13Z,_ w.'
APN
OWNER
CONTRACTOR
SPARKS CONST -RUC I`%ON
TD. DESERT 1' J.T?LrEl.OxaNtE;'v'1` U
79-2.95RANCHO .LA Q(;E,.,NrrA DR.
1.0,13OX 1716
LA QUTlw"FA CA 92253'
LA QUINTA. CA 922.5.3
;101771.10 1 !i 100 .
DESIGNER/ENGINEER
,
(6 1 9}771-1944
USE OF PERMIT.
SINGLE ,FANIIIN UWELLIANG
RANCHO LA QU1N 1'A.
TEM AZA PLAN 2
FEE DESCRIPTION
FEES
f
C".US'1'OM CONSTRUCTION X2,572.00 S
POR.CI.1< PA.17.10 t 115.00 3
GARAGEIC'.ARPORX 185.00 S
ESTIMA1`ED COSH' OF CONST'RUC'TION
PXR111ET FEE SEAtTMARY
PLAN 4:DECK I' E? 101-000-439-318 $879.46
C'OiNSIRUCTION FEE, 101-000-1918-000 $1,035.90
tf
'WW'C HANJ,'C'AL .FTE 1.01.000-421-000 $142.50
i lrf: t't2 icAt. F � 101.000-420-000 $197.22
PI.1A1BING FFE, 101-000-41,9-000 $•18&00
e'1014G MOTION E'er:' - RE:"SUD 101-{)1V-241-000 $21.53
GRADING FEE 1.01-003-423-000 $2.0.00
lNFRA:1't't2.U& ij E FFE 225 -OW -44' 3-342 $4,8.10.16
PR F FLAN 10:1-000-441-.3.:15
ART IN E'LBLIC..PLACIES - RESIL 701-000--235.000
r ;
CONSTRU , ON AND 1'I,1,.`1w1 CHECK
57,617.66 f
LESS PRE -PAM FEES
� $0.00
FFe
'23
1996 TOTAL .PERMT 11+.1 s DUEE NOW
$7,617.66
.,,
RECEIPT
DATE
BY
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
Z—
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
L
Final — G
Final o—
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
Vg-1g-qe 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 - G C /L
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FoQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 27 -
Utility Notice (Perm)
COMMENTS: