9602-014 (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
OLO
License is in full force and effect. 674074 13 i/97
n W License#}, Lic. Class -r Exp Date
rZ Date , 1,N , 19 ,SignatureofContractor
0 OWNER -BUILDER DECLARATION
_jILJ U 1 hereby affirm that I am exempt from the Contractor's License Law for the
LLj CL following reason:
I.- 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).
( ) 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
N
02 rn WORKER'S COMPENSATION DECLARATION
Q_ Q I hereby affirm under penalty of perjury one of the following declarations:
C) Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
In 0 compensation, as provided for by Section 3700 of the Labor Code, for the
XW LL. performance of the work for which this permit is issued.
Q J J ( ) I have and will maintain workers' compensation insurance, as required by
C0 Q U Section 3700 of the Labor Code, for the performance of the work for which this
p U permit is issued. My workers' compensation insurance carrier & policy no. are:
rn �. Carrier Policy No.
IT Z (This sectl.4,^eL'.41ti�le completed if the permit valuatiopys1fq9�1y00.00 or less).
CO Cy () I certify that in the performance of the work for which this permit is issued,
Cy
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 Section..3700 of the Labor
Code, I sh I forthwith comply with,-ftse provision¢
Date: -), I / ,7 Applicant C , \_ •
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
correct. I agree to comply with all City, and State laws relating to the building's
construction, and hereby authorize representatives of this City to enter upon the =
• above-mentioned property for
inspection purposes'. r /�
Signature (Owner/Agent) (_ t Date' # 1 1
""'
BUILDING PERMIT
PERMITS 0
14
DATE V 1/96
VALUATION $214,314,$11 LOT 127
TRACT 27&10
JOB SITE ADDRESS 48-530 CA;PIST.RANO WAY
APN 646-390-1119
OWNER
CONTRACTOR
SPARKS COMINR.UCTION
7..0. , _Sk?R".I'.c)1:VELM%4ENT LP
101 411ALVON BRIDGE RD NO.
P.O. BOX 1716
Lix QUINF A CA 92253
L.A. QUINTET CA 92253
(619)771-1941 CBLO 2996
(619)771-1941
DESIGNER/ENGINEER
USE OF PERMITl1NGlL :, FATWIL.Y DWELLING
¢
RANCHO LA QU I.NI A
T RI2AlA.PLAN2
FEE DESCRIPTION
FEES
CUSCOMCONS!'RU]CTIGN 2,¢72,00 SF
PC"IC"ATLO 115.00 SF' L
GARAKOCARPORT 685.00 8F
ESTIMATED COST OF CONSTRUCTION'
214,314.30
1"ERM11 EE SiJM1!'fi.A1RY
Pi,AW t-FffCX FT;r 101,-000-439.318 $r9 A6
C:C)NSTRUC'1710N Imo?: 10L-0001118-000
A18CkiAh1ICAL ME 101-000-421-000 $142.56
ELFC" T TUC At.:Frm 101-000-420-000 $1.9'1.26
,P1,OW11rNO F' FIR 10! -(M-419-00() 5188.t10
5°I O�t0 M01•.I.0N F& - R€ 311) 101 -000 -741 -OW
v1LADIN'U FiT 101-000-423-000 $20.w
INFRASTRUCTURE FEE 225-000-443-342 $4,81.0,16
P-RECIM!, )'i.,.AN )(11-M-0-40-345 $2115.00
AItT IN I'iJPLIC PLACES - RESIC 101.000,255-000 $258,29
SUB -TOTAL CONNrRWfl0N AND PLAN CHECK
$7,617.66
D LESS FILE -PAM .FEES
$0.00
���rr.�ia. PE101c7 EES DUET OW
FFe
57,617.66
2 3
1996pill
RECEIPT
BY
DA
TE RNALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
lj
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
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
1Z
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date . 2/13/96 APN # 646-390-019
No. 14154 Jurisdiction La Quinta
Owner Name T.D. Desert Development Permit #
No. 48530 Street Capistrano Way Log #
City La Quinta zip 92253 Study Area 123
Tract # 27840 Lot # 126 Square Footage 2572
Type of Development Single Family Residence No. of Units 1
Comments
By
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 2,572 or $ 4,423.84
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By T.D. Desert Development Telephone 771 1,941
Name on the check -
Dolores A. Ballesteros
Superintendent �, z
Fee collected /exempted by Pauline Pearson Payment Received $4,423.84
Check No. 7881
Signature v� A Iyt_6-A
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/Receipt Copy - Accounting