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9601-169 (SFD)LICENSED CONTRACTOR DECLARATION N E I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with r W Section 7000) of Division 3 of the Business and Professionals Code, and my 00 Oco License is in full force and effect. 674074 N 7/31/97 W ^ License # Lic. Class Exp. Date-, ri Date ,A ii-, /AignatureofContractor t O) Z P OWNER -BUILDER DECLARATION J 10 1 hereby affirm that I am exempt from the Contractor's License Law for the CL 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). ( ) 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 O rn WORKER'S COMPENSATION DECLARATION Li Q I hereby affirm under penalty of perjury one of the following declarations: o g Z () I have and will maintain a certificate of consent to self -insure for workers' u) 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 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: LO Carrier Policy No. ? ? (This sectj9pIn dot&e completed if the permit valuation?isjfgr$1-90.00 or less). � O () 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 Section -3700 of Labor c Code, I shall forthwith comply with tK63b pro Date: 3 s in 1 n Applicant 1. l 4a a v 9, 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 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. 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 forinspectionpurposes. t, Signature (Owner/Agent),,+0 i �•�'-1 Dated A"' BUILDING PERMIT PERMIT 9601-169 DATE 2/11/96 VALUATION LOT TRACT Y j /,', 4V JOB SITE ADDRESS 48-50 CA!'I.S ANO WAY APN 646-:E$W018 , OWNER CONTRACTOR SPARKS CON917R.IJ&TON T.D. DESEMI' DEVELOPM NT LP 79-295 RANC1401',A QiJfAI'1'n. DIL Ro. }SOX 016 LA QtJ`IWA CA 92253 L.H.QWNTtil. CA 92253 (619)T71-1941. C..81.4 2006 (60)771-1.941 DESIGNERIENGINEER USE OF PERMIT f. l iL { FAMILY E L INI , RA1y040 LA QU1Mt'A FEE DESCRIPTION FEES Ci38T m coNstrit'ucri©ta 2,2.00 LF POR.CH/PA.7`.T.O 170.00'.3F GARt\.Gk7.J ARP0RT 486.008F RS'1 IMATFM COST OF CONSTRUCTION Pt AN C! ra;3y YEF, 1014W-439-318 439-3.1.8 5774.54 CONS TRUCTION .FE13 101 -OW -418,-000 %140.50 IrW-HAMCAt, FUM., 101.-0(34-421-000 598.5+0 FLE,C:'T'R C'AL FELE 101.-000-420.000 5167.81. PliM) .1W3 TIFF 10.1-1;113(1-419-000 $142.00 ..'1'CY1':O Iv1O1'fON;rI-1, •• RES ID 100-000-241.-000 518,56 GRADING FEE 101-000423.000 $ 0.00 1NFRA.S'f'1+RlJC'I13ii1✓ FJ' Y, 2.25.000-443-342 $4,174.71. A -RT !N P1TBMr,1PCAG $213.95 'tsI TO tL C' IS"TFcUCTION AND YL AN C!-1IsC:t�' �J $6,500.57 LESS FRE -PAID FEES $0.00 V -FEB 2 3 1996 .TAL 1'I;Itls1.1'.1' ru s oiilc Ncavv She 69li57 By RECEIPT DATE BV 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 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 Law Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: h a _ CITY OF LA Q,UINTA . BUILDING'& SAFETY DEPARTMENT 777-7012 INSPECTION REQUEST LINE 4\ 777-7153 T.D. DESERT DEVELOPMENT Owner—' Contractor SPARKS CONSTRUCTION 9601-169 Permit Number POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES .48-540 TRANO WAY JOB ADDRESS SFD PLAN 1 LOT 126 TYPE OF INSPECTION DATE INSP. FOUNDATION.& SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING 77 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 ABOYE HAS BEEN SIGNE DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK - (' i FINALS ELECTRICAL PLUMBING FINAL GAS TEST HEATING -A/C HOUSE NUMBERS - U' G j JOB COMPLETED TEMP POWER /7 ABOVE APPROVALS DO NOT INCLUDE RIGHT TO 1/95 TURN ON UTILITIES OR OCCUPY BUILDING Notice: Document Cannot Be Duplicated Date 2/13/96 No. 14153 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Owner Name T.D. Desert Development No. 48540 City La Quinta Tract # 27840 Type of Development Comments By APN # 646-390-018 Jurisdiction La Quinta Street Capistrano Way zip 92253 Lot # 126 Single Family Residence Permit # Log # Study Area 123 Square Footage 2231 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 2,231 or $ 3,837.32 the property listed above and that building permits and/or Certificates of Occupancy for ....tea ..: , this square footage in this proposed project may now be issued. == Fees Paid By T.D. Desert Development :Telephone✓ - 771-1;Q41 Name on the check z_ Dolores A. Ballesteros J;� Superintendent y Fee collected /exempted by Pauline Pearson Payment Received $3,837.32 Check No. 7881 Signature Collector: Attacha 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