9601-163 (SFD)(n LICENSED CONTRACTOR DECLARATION
N j 1 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
F^ Q Lo License is in full force and effect. 674074 13 713.1197
r_ W j License # r` Lic. Class Exp..O e- -
n n Date , /� SignatureofContractor f � , i
Z -
ca P d> OWNER -BUILDER DECLARATION
-i W 1 hereby affirm that I am exempt from the Contractor's License Law for the
CLfollowing 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).
() I, as ow,9er ofrthe•-property;-am exclu�siivvelly contracting with licensed
contracto •to con_struci the (I
0441.Busln & Pro�issionals-Code).
(
)-1 exem It under Sectiq r &P:C. for this re4sonN_/ i`
LO
Dater e�}L � �Signatu eof• Ovuner-
Orn
WORKER'S COMPENSATION DECLARATION
CL 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 self -insure for workers'
Lo HO 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.
O 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 Lo Carrier Policy No.
Z (This secti6h,% , "d" nd'ft b completed if the permit valuatioh•is � I fb0.00 or less).
t` ( ) I certify that in the performance of the work for which this permit is issued,
O 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 Sectio3700 of the Labor
Code, I shall fo,Thwlit�h comply with those rovis of n�,/
Date: i«31cF Applicant / r/gyp
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 pu poses., ry %
" ISignature (Owner/Agent)� DaEe t
Lel
ALCM '
�, ABJU,ILDING PERMIT
,�RMIT16�1-363
DATE `'
VALUATION ' " ""
LOT TRACT
JOB SITE ADDRESS 4&!595C "ffTite%NO WAY
APN 646-390-007
OWNER
CONTRACTOR
SPARKS CONST,RUC!'l,ON
'r.D.D)'✓S1 R c D WICIP(Vik1w T,11P
79-295 RANCHO LA QUI'`Ti'ADR.
P% 0. BO .11 I6
'Lit QUrNTA CA 92.2533
LA QU:[NfA CA 9.2253
(61!!)771-1941 CBL!# 21W
(6110771.-1941
11""G r r•a ar s ria^ s, -iv vi.r
DESIGNER/ENGINEER
+r ,
USE OF PERMIT' az
RANCH(.) t,A taUIM,A.
iTFf R",A PLAN t
FEE DESCRIPTION
FEES
C LIS'PO.M. (.ONSTRUL lION 2,231.4 0 LFA
.PORCM/PATIO 170.00 Sf
GARAG1i CARPORT 486.00 Sr
ESTIMATED COST OF CONSTRUCTION
1 13-414;a1..50
l�ci,iltml�x.wl�;lae a]P.J�'AL�,f.A�E
Pl.AN'C1•i.►iCK FFE 1,01-000-439-319 1774-54
CONST RUCTION F IX 1.01-000-47.3-000 $9401 50
W CHANICAL Mi 101-000-42t-000 $98.50
ELECTRICAL FFE 101-000-420-000 $167.81
MAJI MYNO FFF. 101-0(30-419-000 $.142.00
STONG MOTION FEE - REsSID 100-000-241-000 $18.56
GRAt1INO I'M 101-000-423~000 5220.00
lWFRASTP.UC URE FEE . 223-GW.443-342 $4.12.71
ART TNVU61.IC PJ ACF..S - RF-,�STT.� 701-000255-000 521.3. 5
"LIB -TO'; AL CONSMUTMOiN AM) 1?LAI'?' C tECK
$6,5()0.57
D ^ LESS PRL' -.PAID k`ECS
1$0.00
FEB • T'O'NAL 1PE3+`krf FEES UE NONY
23
$6,500.57
1996
f +'
RECEIPT
DATE
BY
DATE RNALED
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 8 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:
{
i
a
s`J c CITY OF LA QUINTA
!c�IBUILDING & SAFETY DEPARTMENT
+✓ '�' 777-7012
INSPECTION REQUEST LINE
777-7153
Owner T.D. DESER
Contractor SPARKS CONSTRUCTION
9601-163
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-595 CAPISTRANO WAY
SFD PLAN 1 LOT 115
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 PLUMBING
ROUGH GAS & GAS TEST
H EATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING 5 —
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOV HAS BEEN SIGNED
DRYWALL INTERIOR G
EXTERIOR LATH Aw
POOL PRE PLASTER
L FENCE & GATE
$EWEO SEPTIC TANK 1 T l7G
FINALS
ELECTRICAL C
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
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
.Date 2/13/96
No. 14141
CERTIFICATE OF COMPLIANCE
APN # 646-390-007
Jurisdiction La Quinta
Owner Name T.D. Desert Development
No. 48595 Street Capistrano Way
City La Quinta zip 92253
Tract # 27840
Type of Development
Comments
Lot# 115
Single Family Residence
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 j -Telepdpne
Name on the check ? .,
By Dolores A. Ballesteros ~' : ` C�:
Superintendent
Fee collected /exempted by Pauline Pearson
Signature Q 2 1 �onn G Ic Si t%Lt /l A pM
��rq..
Payment Received $3,837.32
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