9602-012 (SFD)cn 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
= M License is in full force and effect.
d LO
n UJ.- License #' 1 LIch7CiitU6 13 Exp. Dats,, � ,1197
r Z r- `
Date ,'f % SignatureofContractor /� f�i
O oh OWNER -BUILDER DECLARATION }+
LL
UJ W ' I hereby affirm that I am exempt from the Contractor's License Law for the
I— 0- following reason:
LO 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
L Date Signature of Owner
N
rn WORKER'S COMPENSATION DECLARATION
EL Q 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 sell -insure for workers'
Lo Fa- ¢O 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.
p J J () 1 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:
rn H Carrier Policy No.
'T Z (This section need not be completed if the permit valuation is for $100.00 or less).
N C) () I certif�tThfatliA%Vperformance of the work for whiWtWs(1A6t 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 shall forthwith comply with those provision
Date:',.. a:,. f .�, , Applicant t
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in.
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read•this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
• igove-mentioned property%fovinspection purposes. ^�
► , . Signature (Owner/Agent)1 w ' \ Dat�e�/:
ALCM
BUILDING PERMIT
PERMITi
�ie=af)�.i312
DATE v y,n;
VALUATION21`3 �� � LOT 12� TRACT .a7ajo
JOB SITE ADDRESS
APN
dl&574)CAP1'ST "VO WAY
646406-015
OWNER
CONTRACTOR
SPARKS CONSTRUC rION.
T.D. DESERT Ian VEJ,.taPMFNT SLP
101 W.ALSTONI 1 RIDGE RD NO.
R.O..€3OX 1-116
LA tilt"lN`,I A i CA 92253
CPA QIUINTA CA 92253
(61 U19:1 .10.43'K 'tat ff D �'K
DESIGNER/ENGINEER
(§19)771-1941
USE OF PERMIs.w YIX FAMI LY DWEI,I.bNG
'KANCHO LA QUINTA
MW,A PLAN y
FEE DESCRIPTION
FEES
CUSTOM CONSTPU1CTION Z.172.0 &;F'
PORG'WPATIO 10.00 Sp
gARAGFN_'ARPQRT E,$,5.00 3F
r,,',gTIMAIFDCO.STOFCONSfRUC-TION
2i5,3,14.30
aPFRll ,Ff FEE SUMMARY
'PLAN OIO*CK r.IfM 101-M-439-318 $879.46
COt3>S'Wf"1'.IO.N rD E 101-000-#113.00^ $1,045.50
Wc.i ANICALVU; 101-W-4.21:000 S142_%
ELEC I DUCAL !~U, 10.14)00-420-000 SI97.22
f''q.i AMNO FIS. 103-)00.41.9-t' W $i.8,8V
- STOW MOTION F= - RESIN 101,0DO-211-400 $2.1.53
GRADING FW 101-000-423.000 $2010
INFRAS'rRUCrill::E:FFE 225-000-413-342 S4,810. i6
PREXISN RLA'N101-(M-441.345
iNRI,' M:PL?BLICPLAC€aS--tcESLC 701-000.255-000 5288.2.9
SUS -TOTAL CON1`UO'�ic� ,R �tu.#�CA C'.I CK
$7,617.66
TIPSS►R-I?A1I FEES
FM ZA
$0.40
FEB 2 .. .
3
1996
RECEIPT " "
OAT, E
BY
DATE FlNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE-
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
ti
s CITY OF LA QUINTA
fr OF BUILDING & SAFETY DEPARTMENT
777-7012
0 INSPECTION REQUEST LINE
�V777-7153
Owner` —A DESERT DEVELOPMENT
Contractor` SPARKS CONSTRUCTION
9602-012
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-570 CAPISTRANO WAY i
SFD PLAN 2 LOT 123
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
i
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC I
I
ROUGH PLUMBING
ROUGH GAS GAS T
HEATING & VENT -A/C I
FIREPLACE I
ROOF
i
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION `—
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR - -
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL �
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS i
JOB COMPLETED �/ I
TEMP POWER I
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
I ,9� TURN ON UTILITIES OR OCCUPY BUILDING s
0
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. 14150
Owner Name T.D. Desert Development
No 48570
City La Quinta
Tract # 27840
Street Capistrano Way
Lot # 123
Type of Development Single Family Residence
Comments
APN #
Jurisdiction La Quinta
646-390-015
Permit #
Log #
Zip 92253 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 Telephone 771-1941
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $4,423.84
Check No. 7881
Signature
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