9601-162 (SFD)cA LICENSED CONTRACTOR DECLARATION
N 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
0 0 � License is in full force and effect. 674074 B 7/31/9'7
r_ W n License ; % Lic. Class Exp. Date
On Date!^�,SignatureofContractor
ca o) OWNER -BUILDER DECLARATION
IU 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).
( ) 1, 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
OU rn WORKER'S COMPENSATION DECLARATION
a 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 HO compensation, as provided for by Section 3700 of the Labor Code, for the
X LU 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
Q U permit is issued. My workers' compensation insurance carrier & policy no. are:
W u) Carrier Policy No.
v Z (This sectfiii'iiik*h0jffe completed if the permit va1uatioh11M,$W.00 or less).
r- d () I certify that in the performance of the work for which this permit is issued,
g 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 f Section 37 of. a Labor
V = Code, I shq forgnwith comply with those 1�rov'Ip
Date: 3 I '' 42 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 rp es.
Signature (Owner/Agent) Date
A"'
_B _I DIN PE = MIT
PERMIT4",_1i:
DATE
_
VALUATION LOT -11L TRACT
JOB SITE ADDRESS saw L"IsT11 mo wAy
APN 64641"16M
OWNER
CONTRACTOR
SPARKS CONSfRiK�nM
T.D. DESERT DEVELOPMENT LP
79-295 RANCHO LA QUINI'A DR.
P.U. BOX 1716
LA QUINTA CA 92253
LAQUINTA CA 92253
(619)771-1941 CBL#! 29%
(619)771-1941
-lJ
DESIGNER/ENG[NEER
USE OF PERN011'4 L 11L / LJ 01.1.11
RANCTIO LA QUINTA
'1713MA7.A PLAN 1
FEE DESCRIPTION
FEES
t.'U37'om CUNSTRUc.' rKW 2,231.00 LF
PCAIC i/PATIO 170.00 3F'
QARAOWCARPORT 486.00 W
ESTIMATED COST OF CONSTRUCTION
1041MI 40
PERMIT FEE SUMMARY
PLAN (WX1( FFF. 101-000-439-318 "4.54
Ct_)NSTRUMON FEE 101-000-418-000 $940.30
MECHANICAL FEE 1014)00-421.OW $".So
6LI6CPRICAL FEE 1014000-424000 $167.81
PTARABINCF FRF 101-000-419-000 S1142011
STONG MOTION FEE - REM 10044241-W0 $18.56
(X A AM FEE 101-000-423-004 120AK)
11NOXASTRUC 111M FEE 22-541100-4436-342 34.124.71
ART 1N PIM1.1C Pf.ACEB - RFM 701400-25S-00(} S^13.91
SUB -TOTAL CONSTRIA-TION AND PLAN C11Ec.i
LESS 1'RE-11AID FEES
$6,.4 57
$400
TOTAL PFRMIT II rLM DIIE NOW
S6.5e0.57
2 3 1996 /
`
RECEIPT
'DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
r
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:
c.
t
a
,CITY OF LA QUINTA
C.
OF - 'y BIDING & SAFETY DEPARTMENT
C`;' �� 777-7012
�ryj Cj' INSPECTION REQUEST LINE
`� Fr 777-7153
Owner T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9601-162
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
48-565 CAPISTRANO WAY
JOB ADDRESS
SFD PLAN 1 LOT 112
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
U
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN S ED
CONCRETE SLAB
6
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
J•. G-
HEATING & VENT - A/C
FIREPLACE
ROOF
-
BOND BEAM
O.K. TO WRAP
GROUT Cl 4' ❑ 8'
FRAMING
-
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNE
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL /0
PLUMBING
FINAL GAS TEST I
HOUSE NUMBERS
JOB COMPLETED U
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING
t: