9601-160 (SFD)LICENSED CONTRACTOR DECLARATION
N C ` 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
CD C) LO License is in full force and effect. 6741)74 B 7/31/97
r W License #, / Lic. Class Exp.•Date
Z n Date .1 > � ,�s C.fSignatureofContractor�%
7 -Y
F- 6 OWNER -BUILDER DECLARATION 1
J IU GO I hereby affirm that I am exempt from the Contractor's License Law for the
0_ following reason:
W( ) 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
NDate Signature of Owner
rn WORKER'S COMPENSATION DECLARATION
FL Q 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 H 0 compensation, as provided for by Section 3700 of the Labor Code, for the
X w 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
m 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:
tlLO H Carrier Policy No.
Z (This sectii5hAie-I3'dar &lye completed if the permit valuatioh'ig#69$100.00 or less).
00 N C3() I certify that in the performance of the work for which this permit is issued,
Ci 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 shafc ol rtPth comply with those o`isioh�.
Date: Applicant ,•',/'� ,.-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
%* 1461
& 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.
1 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 property for inspection purposes 1
Signature (Owner/Agent) l Data
per•+*.' i, -V 7" .,.liJ C"e"
ALC
ILDING PERMIT
PERMIT6g-��� F,
_B
i+ h
DATE a it
VALUATION %e'Y-'}`vxw'•
LOT R
TRACT F`
JOB SITE ADDRESS 49-535 CAPKMANO WAY
APN 646-•3$0-02
OWNER
CONT
PARKS CIONSTRUCI`(UN
T.D. DESERT DEVELOPMENT 1Y
79•.295 RANCHO LA. QUiNTA T)R.
P.O. BOX 1716
LA QUINfA. CA 422;
1..A QUINI'A. C;A 92253
(619)`!7)-od t C BL## 2"6
(619)771-1941
DESIGNER/ENGINEER +
USE OF PERM' 1V11 t !r ".f 0V11 .5 1 IWT, t,
KANC;HO LA Qt11N1'A
TORRAZA, PLAN 2
FEE DESCRIPTION
FEES t
CUSTOM CON1111RUCIrIO1N 2572.00 Sk
POR H/PATIO 115.00 SF
GARAGEYCA:MN)i71 685.00 .517,
rt
rKS'T€Ni IATE D COST OF C'ONSTRVC'fION
15,114.3 ,.
PLAN CHECf{.FET, 1.01-000=439-318 $1579.46
CuNSTR UCrt'10KT--1 F lot -•000-1118-000
ML-CHANICAL FEE 1.01-000-421-M $144 G,
F�.EC" T' CAL .Mi 101-000-420-M) $19722
E
P1.t NMIN0 FFE 101-J()f1-419-000 $188.00
3T0 NG MOTILIN FFE - RESID 101.000-241.000 $21.53
0id.Al)lA1G.laES 101. -WO -423-600 $20.(4)
1 N F R ASTRdU(:°'1'URF I -M. 225 -OW -443-342 $4.810.16
PRECISE PLAN .1x11-000-441-3:.1.5 $25.00
ART IN PUBLIC PLACES - Ra :IA13 ` 01-000-.255-0(10 $288.29
<�,SUB-`.f'OTAL CONS'1 OC'i ON AND PLE11\i CHECK
$7,6.t7.,66
OLESS PRE -PARD FEES
$0.00
`AAo-'1OIAI[,1aEITZiwdl'A
1~+US 1�I7� NOW
FFe
$7,, 517.66
2 319
96
RECEIPT
DA-TF,./BY
DATE FINALED
INSPECTOR
■
INSPECTION RECORD
OPERATION
DATE
I 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
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 I 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
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. I
Smoke Detectors
Temp. Use of Power
FinaY
Utility Notice (Perm)
COMMENTS:
s CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
I �? 777-7012
O INSPECTION REQUEST LINE
777-7153
V
Ow ne -"T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9601-160
i. Permit Number -
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-535 CAPISTRANO WAY
i SFD PLAN; LOT 110
TYPE OF INSPECTION
DATE
INSP.
FOUNDATION & SETBACK
FOOTING STEEL
% Lz,
MAIN GROUND SYSTEM
GROUND PLUMBING
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
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEF► SIGNED
DRYWALL INTERIOR
EXTERIOR LATHy-
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL i
PLUMBING
FINAL GAS TEST j
HEATING - A/C
HOUSE NUMBERS ;
JOB COMPLETED k2 Al) qJ7
i
TEMP POWER
4 ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
�-
1/95 TURN ON UTILITIES OR OCCUPY BUILDING
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
No. 14133
Owner Name T.D. Desert Development
No 48535
City La Quinta
Street Capistrano Way
Tract # 27840 Lot # 110
Type of Development Single Family Residence
Comments
By
APN # 646-390-002
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 123
Square Footage 2572
No. of Units 1
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 Tele! iAone' 771-1941
Name on the check
Dolores A.'Ballesteros "
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $4,423.84
Signature ,(J� A QIA-,0 P) A(A A Wyk,
Check No. 7881
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