9602-007 (SFD)LICENSED CONTRACTOR DECLARATION
N 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
o = in License is in full force and effect. w�( ��,5
r 1f' �Re1, lJ 1P)•%J1
n n License # i / UOU941, Exp. Date?--4'P
Y97
Date .< .t f ?,.:`%/Signatureof ntractor
c'o 0n
0) OWNER -BUILDER DECLARATION U
J IU I hereby affirm that I am exempt from the Contractor's License Law for the
0_ following reason:
U) () 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 Signatureof Owner
N
OU rn WORKER'S COMPENSATION DECLARATION
CL Q I hereby affirm under penalty of perjury one of the following declarations:
o g Z ( ). I have and will maintain -a certificate of consent to self -insure for workers'
LO g cc 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.
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
p U permit is issued. My workers' compensation insurance carrier & policy no. are:
d rn H Carrier Policy No.
? j (This section need not be completed if the permit valuation is for $100.00 or less).
00 CY () I certify that i�irlfi'e�performance of the work for whiff 1 tIHtVjArmit 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 Sectlon'3700,of the Labor
Code, I shall forthwith comply with those provisions.
Date: t.3 P} f ' df Applicant a
Warning: Failure to secure Workers' Compensation overage 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, indemnity
& 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 1 S days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
1 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 ins act ur oses'.
F
Signature (Owner/Agent) _ Datas
ALC#
BUILDING PERMIT
PERMIT i
;610
—0417
DATE2/ Z�1)
VALUATION % T13i4 (r
LOT 14 TRACT M 7 40
JOB SITE ADDRESS
APN
4.9-525%C IS ' NO Vi'
64iS..M.r"
OWNER
CONTRACTOR
PARIeS CON
1 IiR,.
.1.5✓, n✓�La )i R.ii I'VE' .til !4f.N1' 1,40
ZA-`i +u��1R�.1'i4� �.i �p�)N , d 4-D
PD. Box 17 16
LA. QUIWA CA. 92253
LA. QUINTA "I CA, 91253
(619)771 !P4t
DESIGNERIENGINEER
tfe 1.9i77I - I94l
F(
USE OF PERMI:;TNGL.E 1,4o11LY DWEE'LLING
RANCHO C.A. QVIN71-A
TE7RRAZik P1. AN a
FEE DESCRIPTION
FEES
`4
C04*1'JIM CON.41'tlJC;'C ION 2,572dk) :3F
P0ELc:.1YPA:r10 11.5.00 Sri
®ARAS. EXAR1-'C712 t 685.01) Sr!
013 ATI MATED COST Ctrl;', CONSTRUCTION
2I5,314.30
PIu:R1V[.IT FEE SUMMARY
PJ.AWCHFCK M. 101.000-439-318 $879,46
COMI TRUC3101N FIX, 101.-000-418-000 $045.50
MECHANICAL iIS 101.000 -421 -ON $142.50
1^..I.I CTRICAL FEE 101-M-420-000 $197.22
P..uv1BING FES 101 -MO -419-000 $188.00
VfONG MOTION A "'i - RESID 101-000-241-0000 32.1.53
GIRADINc1 FEE. 101-000423-000 S20.00
LN'FRA.S'TRM TAJRE FEE 225-000-443-342 $4,81.0.1.6
PRJFCrSE PLA'Id 101-000-441-345 $25,m
.AxrwT'ITBL10PLACE S-.R&Slr 701-01XI-255-000 $2.$8.2'11
1
D
;D .
FEBS'13 TAL ST11,"U IGN. AND PLAN C'.HKK
$7;617,66
996 LESS PRE -PAID R-tS
$0.00
�y`--��
i SAL' PiN:%MI`I' FE S DUE NOW
$7,617,
F-
A .
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTO
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 Wali 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
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
a �
CITY OF LA QUINTA
�.o,:BUILDING & SAFETY DEPARTMENT
C � 777-7012
INSPECTION REQUEST LINE
777-7153
OwnerT.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9602-007
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
48-585 CAPISTRANO WAY
JOB ADDRESS
SFD PLAN 2 LOT 114
1
EOW
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
t
GROUND PLUMBING
PRE-GUNITE i
DO NOT POUR CONCRETE UNTIL ALL ABOVE H BEEN IGNED n
CONCRETE SLAB o \v)
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
z
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
i
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 BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POO FENCE & GATE
EWER EPTIC TANK 1
FINALS
PLUMB[
H EATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING
Notice:
Document Cannot Be Duplicated
Date 2/13/96
No. 14140
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN # 646-390-006
Jurisdiction La Quinta
Owner Name T.D. Desert Development
No. 48585 Street Capistrano Way
City La Quinta zip 92253
Permit #
Log #
Study Area 123
Tract # 27840 Lot # 114 Square Footage 2572
Type of Development Single Family Residence No. of Units 1
Comments
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.
v
Fees Paid By T.D. Desert Development J Telephone 771 1:941
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $4,423.84
Signature P_f k AA f xnn9 le 9 �U� ,�ID�✓l
Check No. 7881
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