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9601-168 (SFD)cA LICENSED CONTRACTOR DECLARATION N U) 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 F� O Lo License is in full force and effect. (j7J,074, 7 ri W Cr ^ License # % Lic. Class w" Exp. Date �� n� Date . > / !S 0 SignatureofContractor r� i.. Z � F t cD F- 0) OWNER -BUILDER DECLARATION ,J W - I hereby affirm that I am exempt from the Contractor's License Law for the 0- 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 CO Date Signature of Owner N rn WORKER'S COMPENSATION DECLARATION d< I hereby affirm under penalty of perjury one of the following declarations: o 2 Z () I have and will maintain a certificate of consent to self -insure for workers' Lo H WO compensation, as provided for by Section 3700 of the Labor Code, for the X W LJ_ performance of the work for which this permit is issued. QJ _J () I have and will maintain workers' compensation insurance, as required by co Q U Section 3700 of the Labor Code, for the performance of the work for which this Q U permit is issued. My workers' compensation insurance carrier & policy no. are: a H Carrier Policy No. Z (This sectilgpjn90.c[ of be completed if the permit valuation?isjfora$1.Q0.00 or less). CO r 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 off ,the Labor Code, I shall forthwith comply with those provisio s r Date:` - I ''j (r' 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 p addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. 1 [ IMPORTANT Application is hereby made to the Director of Building and Safety �Ll 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 ,. � rSignature (Owner/AgT{ ent) M ! # Date A`cO BUILDING PERMIT PERMIT• 9601-168 DATE / /6 VALUATION Pl yw� 1.:+ LOT t' el TRACT JOB SITE ADDRESS 48-564) f.iViSTRANO WAY APN 6461-390-016 OWNER CONTRACTOR SPARKS C0NS'TRIJCT 0X T.D. IDESERT 1 13Vf 1110PW119T 1,1p 79.295 RANCHO LA QUINTA DR, F.C. BOX 1716 Lik QUINTA CA 942253 (.,A.Q"tJeNTA CA 922,5; (619)771-1941. C13I1ff. 2$96 (019)-771-1941 DESIGNERIENGINEER USE OFPERMIT,,*N t. ' J,ATv11LY IJWE1.LINU- RA14CN0 :LA. QUINTA "i'`NRRAZA. PLAN t FEE DESCRIPTION FEES C U':MrK M C ONB'T1iZfL:1'ION 2,231.001..#' PORC:,'HJPA.rio 170.00 Sf GAPAGE/C".ARP©RT 8$6.40 S3 ESTIMATED COST OF d"'tJNSTRUC Y ION PERMIT FTJE SUMMARY 9?'t.ALN C;}frX FFIF; 9111442.)1.)-439-31.8 $'^4,"i4 C0,143111YUi." fJGN rEE11 101-<)W41:8=000 89+10.50 NX, C411ANICAi. Fri 101.000 -421 -ON 599-190 ELLIC'1'£t1CAL PE4 101-000-420-000 5167.81 z ,i1l�iFtiNC1.!~7Ir 1(91-000-41.0-f)1i0 5142.00 frl"0140M(YnONFI :1r -1W510 100-M-241-000 $18.56 OkA1KNO FE1. 101.000-473-000 520.00 INFRASTRUCTURE, FU 22 4)OO-44,fi-342 54,129.71 ART M PUBLIC RESi,G' 701110W-255-000 o � a°rte; ct r 'TRUCTION, AND PLYW CHECX $6,50057 I.US PRE,-PA10 Fr,%, $0.00 FFe 2 3TOTAL IE E RMff VEES D UE NOW $6,500:17 19 y 96 RECEIPT DATE BY DATE FINALED INSPECTOR '� INSPECTION RECORD f 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 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: a s CITY OF LA QUINTA fro„O .,r , BUILDING & SAFETY DEPARTMENT Q 777-7012 INSPECTION REQUEST LINE 777-7153 Owner ' D DESERT DF.VF,IIOPMENT Contractol;5PARKS CONSTRUCTION Permit Number 9601-168 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 48-560 CAPISTRANO WAY SFD PLAN 1 LOT 124 TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING - - PRE-GUNITE DO NOT POUR CONCRETE UNTIL A L ABOVE CONCRETE SLAB A BEE SIGNED JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & AS TE �9 HEATING & VENT--AVC— FIREPLACE ROOF - BOND BEAM O.K. TO WRAP GROUT ❑ 4' ❑ 8' FRAMING INSULATION — r PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR Selz EXTERIOR LATH C r POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK FINALS ELECTRICAL PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED v• C9 TEMP POWER