9602-011 (SFD)LICENSED CONTRACTOR DECLARATION
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
C) C3 c� License is in full force and effect. w
O � 6"740 i4 '� !/3ti� �
n W License #I { Lic. Class, -Exp-.Date
rr- Date 1. i v % ✓ Signatureof Contractor
O7 OZ r-- � c_r. 7
ca H rn OWNER=BUILDER DECLARATION
LLj �
U� '1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
I.— (L
O 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).
O 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
CY) Date Signature of Owner
N
WORKER'S COMPENSATION DECLARATION
a Q I hereby affirm under penalty of perjury one of the following declarations:
g Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
LO 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.
p 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
O U permit is issued. My workers' compensation insurance carrier & policy no. we:
a' rn H Carrier Policy No.
IT ? (This sectigninggdirto, .9 completed if the permit valuation s.,foy1 Q0.00 or less).
00 () 1 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
g 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 -p11 +gvisions:
Date: 111 �� i, 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, j
& 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'isg
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�ip spection p, rposes.
Syrnatrlre (Owner/Agent) iVJ 14
'ALC '
BUILDING PERMIT
PERMIT�I�
DATE '211/9.6
VALUATION $2153F 21 TRACT ZifqC
JOB SITE ADDRESSAPN
V�
. 4$,'590 C".1+ RANO WA
OWNER
CONTRACTOR
'
SPAS-kS CONS`T1•i;:CTC, nbN ;.
-1r.,D 0F.$)3K, OE LOPM t4i
101 edVALSTON 8�.1DC�.E kZ43 O.
P.01.8o 17-16': 7-
,t� Q lt3u 1 A CA 92 53
LAQiJ$'W, A. 'CA 92a5.3
(6I9)17.14941 chi:.# 21996
(619)771-.1.941.
DESIGNERIENGINEER
USE OF PERMIVINGL ; FIA1Vi.l1+Y WELLING
RANCHO LA QuWA
Tf~�RRAZA.1PI.A1lr ,3
FEES
i y�yDESCRIPTION
'Y�pL �+ - p�FEE
! .}•y n (.
'..16JO.f.�w+'M".sil.lv/_l'.0.b�.1JCf�,aOiN 2.572.00 S-
=ORCt U'PA.T,10 115.00 &F
(;ARA.L'iiktCARPO.Wf 085,00 ,9F
ESTI-MAUD COST OF CONST.RXICTION
215,314-40
PERMIT FEE SU.MUNI.ARY
PLAN GRECK :1:EB 101-000-439-318 $879.46
Ci, NS'1`R:l aVIO1ti1 FEE 101-000,418-00.0 $1,04- 5.50 .
iV41-'c^,:H:r NTCA.l' FEM 101-000-421-00 9142.50
EC"M:C':'AI, F'M 101 -ON -4.20-000 $197,22
PAAAMPNtc�����+1�;"tr�E 1011-t�g3/W419-0'00 . $188,00
y r Tl
I iJN MOTION £'iCi�.i K RESID 10t-000— 41-000
GRADING FEE 101-000-423-000 $W).00
MF'RASTRI fC."'1'C]RE FEE 22_`-'000--443-342 54,810,16
PREC"tS'-i'', MAN tol- ft() -441.-345 $15.00
A1'this'i?BLIC"<F'f;.r`10ES-RESM 701•000-.255-000 S288.29
. -A V, .. a1L CON:irRtf�'1'.iONANL) PLAN C: BECK
$7,61'7.66
LES, Pi{ 3 -PAW FE S
$0,00
FEB 2 3.1996
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
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 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:
S
V
a
CITY OF LA QUINTA
- �31 ILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner T -D. DESERT DEVELOPMENT
SPARKS CONSTRUCTION
Contractor 9602-012
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
WAY
JOB ADDRESS
SFD PLAN 2 LOT 121
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
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUM BI_NG--,
ROUGH GAS GAS TES
HEATING & /
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION - G .
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEJEEN 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
JOB COMPLETED
TEMP POWER
f
i
1
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO '
1/95 TURN ON UTILITIES OR OCCUPY BUILDING i
I
r-.�
Notice:
Document Cannot Be Duplicated
Date 2/13/96
No. 14147
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Owner Name T.D. Desert Development
No. 48590
City La Quinta
Tract # 27840
Type of Development
Comments
Street Capistrano Way
Lot # 121
Single Family Residence
APN # 646-390-013
Jurisdiction La Quinta
zip 92253
Permit #
Log #
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 - ,_1e ephone~ 771-1941
Name on the check f
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature f a 6 nn p P'9 X%A Ak ZVK_
T=
Payment Received '$A,423.84
Check No. 7881 t
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