9601-161 (SFD)W
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LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect. 674074 13 7/31/97
License #a I Lic. Class Exp Date'O
Date ' r`..I r 4,) 4/ Signatureof Contractor/
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
( ) 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
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This sect9nfnge'd:rLetl§e completed if the permit valuationysafpr $x.00.00 or less).
() 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 the Labor
Code, I shall fortliwJ'th comply with those provision l ---�
Date: 1 1_ 4- Applicant {
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
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
IALC . 1 BUILDING PERMIT 4601461
1 DAA 90 IVALUATION 917{:x. .:J1y LOT TRACT Z 164M
JOB SITE ADDRESS4 -555 CAPISTRANO WAY I APN 646-390-003
T.f11)1, REP.'f DEVI' 1.F01)AIPMr L00
I.O. BOY.1r1G
LA QUINTA CA 92253
f:6 '?'}771-1 X141.
USE OF
RANC110 .L A t 5i1IMA
'I'MR.AZAK AN I.
SPARKS C(?A1S"TRUCTION
79m295 .MNCHO LA. QUfNTA Tiff.
LA QUINTA CA 92253
t6t9)771-1.941 ("B11A 2996
DESIGNER/ENGINEER
FEE DESCRIPTION I FEES
C USTC M C ONS'1'RfJC,'ITION 2,2.41.()4) 11F
PORMPATtO 170.00 SF
GARAGEICAMORT 496.00 S.F
ESTIMATED COST OF CONSTAMMO r
PERMIT FEE SUNIMARY
MAN 04rXX Ftp.
101-000-439.31
S774
CQNST.1tUCTION FIM
10:1 -000 -418 -WO
$91
MECHANICAL FTE
1,01-000-421-000
198.
1=1,1rML CAL FE
10.1.000-424-000
$167
P(AWBING FE'f?
101 -000 -419 -WO
S.14
STONG MOTION FUS - RL, SID
100-000..241-000
$18.
012. DING F98
101-000-423-000
S20
1NF'.R.ASTRI.TC;" URE FEE
225-000-441-342
$4,124
ART IN'Pt.TBL1C 1'1 RCBS-REST 701.-000-2554000
$213.
RECEIPT
,t
54
50
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81
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56
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71
tis
",-TCYTAL CONSTRUCTION MND PLAN CHECK $6,504).57
LESS PRE.PA.1f) PKES $0.00
Irt-11117Atow0&a rr V17 Wel. 13Ef1✓NOW
>r
2 3199
$0500.57
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
,n Service
Sub Panels.
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
F
a
Ss
_ CITY OF LA QUINTA
Fr OF ,� BUILDING & SAFETY DEPARTMENT
777-7012
C INSPECTION REQUEST LINE
Zzj 777-7153
OW4 •'',D DESERT DF.VELOPMENT
Contractor$PARKS CONSTRUCTION
Permit Number 9601-161
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-555 CAPISTRANO WAY
SFD PLAN 1 LOT 111
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL - O
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 G lG
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 BEEbtSIGN D
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED O
TEMP POWER
I
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/13/96 APN # 646-3390-016
No. 14151 Jurisdiction La Quinta
Owner Name T.D. Desert Development Permit #
No. 48560 Street Capistrano Way Log #
City La Quinta zip 92253 Study Area 123
Tract # 27840 Lot # 124 Square Footage 2231
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 2,231 or $3,837.32
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 ,771-19 1
.� r
Name on the check r i
Dolores A. Ballesteros �=
Superintendent ��: � "it
Fee collected /exempted by Pauline Pearson Payment Received $3,837.32
Check No. 7881
Signature �� n QLnA o \, Q A( A n1.f"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