9601-166 (SFD)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 B - 7/31/97
License #,: Lic. Class Exp. Date'"°"`'-,
Date Signature of Contractor .`—N : �'r N
OWNER -BUILDER DECLARATION r
I hereby affirm that I am exempt from the Contractor's License Law for ttie
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 sectigplgiegdrLgf the permit valuatio�us.�fgy$�,Q0.00 or less).
l� completed i
() 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_3.700 of the Labor
Code, I shall fortFiwith comply with those prs,
ovision-- /�
Date:_ r i/,\-— Applicant � ""�fI A '�~
Warning: Failure to secure Workers' Compensation coverage is unlawful anValll
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 3708
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
I certify that I have read this application and state that the above information i6'I
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 thA
'above-mentioned property forinspectionpurp s. 1 /1 F
•Signature (Owner/Agent) f / 2,777 ,/ t Date - 7 1 /7
A`C'
BUILDING PERMIT
PERMITS
DATE 27 :IUB '
VALUATIONIii�2s"IFl_ ,tiC
LOT 122
TRACT
JOB SITE ADDRESS 43-S30 CAPIS RANO WAY
APN 646.390.0104
OWNER
CONTRACTOR
SPATLKS C ONSL"12LI RON .
T.D. DP.8ERT-laF.V4T,T.-,0PM IT LP
79,295 R NKC1110 LA 4wTA, uR..
P.O. BOX 016,
LA QUINTA CA 92253 .
LA QUINTA CA 927.53
(6.19j•771-:1941 CSI i
(65 19
DESIGNER/ENGINEER
USE OF PERMIT? .NULL4- - AIV LL.1 UW 4LLINi
R ANCHO LA, QVI;f+TTA
'.C(,TtRAZA PLAN :I
FEE DESCRIPTION
FEES
f iJC"1'IOid .'2,23 1.00 LF
C1JS'i'Ctiiul CONSTRUCTION
i'OR.C4Iffr'K1710 170.00 SF
GAR.AGEICAKPCORT 486,W -8
VIVVIMA TE D COST Orr CONST RUCTION
195,581.50
1'1+:RVIU FEE SUMMARY
�i � 1WICK F , 1A 14X))04319 -<*-A 1 R 57774.54 r
lC
���rr�Ny
rg+
MECl?WIC:A1, .UE i0i-Off00�423 -000 $98.50
W&L IRICAL M, 101-000-420-000 $167,81
PI:Cll�ti3;I+I41't'f~ 101 -ON -411,94,110. $142,M
S TONG MCrI7I014 FM, , - RESID .100-W0,241-000 241-000 $18.56
012AWN0 FEE 101-006-423-000 $20-00
��i a t�,S'1�t1JC"CIJr. 3715k 225-W-44.3-342 $4,124.71
AR`!' IN PVMf, IC PLACES - :13E3 T 70140.255-0'00 5713.JS
SLM-TMAL CONMUG'TICzN.AND PLAN CIHEcK
$6,500,57
LESS M34AID FEES
ZA
$0.00
TOTA1,PERNIXITEESDUENOW
$6,$W$7
FEB 2 3
1996
Vim`_
RECEIPT
DATE
BY
DATE FINALED
INSPEC70R ti<,
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 Wail 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:
I
1
s _ s CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
//, 777-7012
INSPECTION REQUEST LINE
777-7153
OwrielM-D DFSFRT DEVELOPMENT
Contracto"SPARKS CONSTRUCTION
Permit Number 9601-166
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-580 CAPISTRANO WAY
SFD PLAN 1 LOT 122
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
i 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 AS TEST
HEATING & V /
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION C
PRE -ROOF
COVER NO WORK UNTIL ABOVE-HA4,1369NSIGNED
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
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING
I
I
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
No. 14148 Jurisdiction
Owner Name T.D. Desert Develoopment
No. 48580 Street Capistrano Way
City La Quinta zip 92253
Tract # 27840
Type of Development
Comments
Lot # 122
Single Family Residence
APN # 646-390-014
La Quinta
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 $3,837.32
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By T.D. Desert Development=;Telephone 1,7.1-1941
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Payment Received .: ,$?;837.32
Check No. 7881
Signature 421�L l f Ng nn nor .�� ,� 7C.4V `,
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