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LICENSED CONTRACTOR DECLARATION
+I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
%taction 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect. 67:1074• T3 . - --fir" 1197
License # t / ; Lic. Class r'"� Exp.aate .-
Date :1 i /. Z eSignatureofContractor + 1/ ', 1
OWNER -BUILDER DECLARATION i
I hereby affirm that I am exempt from the Contractor's License Law for the
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 tabor 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 sect9nJ4etjd'nn4f&e completed if the permit valuatiop isiff9p, 1.90.00 or less).
() 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 3700 of the .Labo)
Code, I shall forthwith comply with those
provisions.
! provisionL�..
D 1? -
�%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
& 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 informatio
correct. I agree to comply with all City, and State laws relating to the built
construction, and hereby authorize representatives of this City to enter upon
DATE Zf .iVIO I VALUATION LOT
JOB SITE ADDRESS 48-600 f,:"ISTRa1NO WAV I
APN
'11), E SERT ;"iE' EL,t Vh4EW Tai
1%.G. BGA 1716
LA. QUINT A CA 92253
(619)77"1-1941
USE OF
RANI 0K) LA QkJJ,N'f A,
'1'0tIW.A PLAN 1.
CUSTOM CONYTt2.UCTIGN
F'O12411TIA110
0ARA00CARPORT
9601-165
SPARKS CONMiJI"°I'iON
719.295 RANCHO 1;.A QUIN'T'A 10,
LA QU%"iA CA (92253
(614)'17.1-1941 1,)33.,4 2996
DESIGNERIENGINEER
2,231.00 L1`'
1711.00 SF
486,40 Si:
EAT1M.A'ITED COST OF CONSTRUCTION
PERMIT r, CE SUMMARY
"MAN C>TX i; CTE
101-(1(10-439-31.R
Slr/4.54
Ct .NS'!RU1QT.fO.
141-00!3-418-000
3940.50
114WHANCCALI L.
101-000-421-M"
9911.14
f�Li3C 1'tTdCAL .t;'�
101.000-424-000
5167.81.
F�Lt�Ni131N<i :E
101-000-419-4()t)
$14" M1
STONGL rMoT14N FEE - MSiD
100 -000 -241 -OUST
W. S6
MADMIG, FEE
1.01-00042.1400
1?v7;RAIVRLIC7'URE FEE'
225-W)0.443-342
$4.724.71.
ART IN PUBLIC PLACES - REC)T: 701 -113W -255 -OW
S213.95
A -X_
FES 23
above-mentioned property for inspection purp ERECFJPT _ /�
Signature (Owner/Agrent) ;✓/ �1 . Date/ � r ' / [w�
1..8:5,ss t.5f)
SU'f141'C M, CONSTRUCTION .AND PLAN C.14ECK $6,500.57
nom_ LESS P.'R&PATD FEES $0.00
`I''O VILL PERMIT FEES VUE NOW
1996
jr
I
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final 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
COMMENTS:
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
r
Final
Utility Notice (Perm)
_ s CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
� v
'r Of /�
777-7012
INSPECTION REQUEST LINE
777-7153
aner 4�T_n_ DF,SFRT DF. .OPMENT
mtractor SPARKS CONSTRUCTION
)rmit Number 9601-165
POST ON JOB IN CONSPICUOUS PLACE
NSPECTOR MUST SIGN ALL APPLICABLE SPACES
)B ADDRESS 48-600 CAPISTRANO WAY
SFD PLAN 1 LOT 120
TYPE OF INSPECTION DATE INSP.
-UNDATION & SETBACK
OTING STEEL
kIN GROUND SYSTEM
IOUND PLUMBING
iE-GUNITE
) NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
)NCRETE SLAB
ISTS & GIRDERS
ECTRICAL GROUND WORK
) NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
)UGH ELECTRIC
iUGH PLUMBIN
. UGH GAS &, S TES
-ATING & VE
,EPLACE
)ND BEAM 1
<. TO WRAP
:OUT ❑ 4' ❑ 8'
4MING
3ULATION G
)E -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
'YWALL INTERIOR
TERIOR LATH
,OL PRE PLASTER
,OL FENCE & GATE
WER SEPTIC TANK
FINALS
CTRICAL
UMBING
JAL GAS TEST
ATING - A/C
)USE NUMBERS
,B COMPLETED
WP POWER
ti
,18OVF APPROVALS DO NOT INCLUDE RIGHT TO
Notice:
Document Cannot Be Duplicated
Date 2/13/96
No. 14146
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. 48600
City La Quinta
Tract # 27840
Type of Development
Comments
By
Street Capistrano Way
Lot # 120
Single Family Residence
APN # 646-390-012
Jurisdiction La Quinta
zip 92253
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.
4 ` v
�J
Fees Paid By T.D. Desert Development `TelepSone _;_771-19 1
Name on the check
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received
Signature DIV A-ki "4 P, ., "O�
Check No. 7881
$3,837.32
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