9602-008 (SFD)PLICENSED CONTRACTOR DECLARATION
N fn 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
FF C3 Lo License is in full force and effect. 67-4074 B 7/31./97
r, W ^ License #, ! Lia Class Exp._ Date"`
rZ n Date ,..3. /) /!/& Signatureof Contractor f ", r!p
cro 0 d) OWNER -BUILDER DECLARATION
J WCD
1 hereby affirm that I am exempt from the Contractor's License Law for the
a following 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 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
LO Date Signature of Owner
N
OU C0 WORKER'S COMPENSATION DECLARATION
CL Q I hereby affirm under penalty of perjury one of the following declarations:
0 2 Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
LO H cc O 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
Q U permit is issued. My workers' compensation insurance carrier & policy no. are:
CL H Carrier Policy No.
Z (This section need t be completed if the permit valuation is for $100.00 or less).
00 I`A" t� fi�3�')"7 It�S<�s
n Q () I ce�tlty that In a performance of the work for whitt tis "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 Sect on 3700 of the tabor
Code, I shall forthwith comply with those provis o s� r
Date:',,'- All / Pad' n 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 Vold 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 purposes,-"
� � f /
Signature (Owner/Agerd) !0 Dais Z+ '� � %fes
ALCM
BUILDING PERMIT
PERMIT96W1008
DATE 2/1/,96
VALUATION S215,314.30 LOT tJ6 TRACT 27840
JOB SITE ADDRESS
41'"03 C-A&IST RAl' O WAV
APN
64"940 08
OWNER
CONTRACTOR
S,ARKS JNS{ 1FOy
'r,D. taut -un, i. 3T?w.LoPP.t>~.N"t' .J
101 WAL.S"1'ON BRIDGE RID NO,
,1.x,0, W:,4,'I tli.6
LA QUIN-FA CA 92253
LAQUWA CA 92253
ft-; 191771-1941 C.F3T.# 2g06
DESIGNER/ENGINEER
61' 17?i ,1 g4 f
USE OF PERMIT. 11grLla 'i1�'iI1�7� DbVGI,1:.iivC
RANCHO I.A. QUINTA.
'i'ERPLAZA.',PLAN 2
FEE DESCRIPTION
FEES
CX) 617<3MCts"14S'1.kUCrJQN 2,572,00 81.1
P01&CWPAX10 1.15.00 SF
0AitASIFJCARPQP.T 685.00 SF
ES71MA'1'E D COST OF CONSTRUCTION
2:15,3A4JO
k"Eid6NOT ,FEE .4iJlMMARY
}'i,AN c.)'1'4;CK x RS IU 1-0(10-439-318 "79.46 i; ,
CONST.IZUCTION FEE 101-0004M000 $1,645,50
ME.C'HANICAL HE 101-000-421-000 5142,30
A
Ef-LE(n'PJCAld M.' 101-000-4.20-000 $197.22
0
.PT 'UNT13INFO :FF -C, 101-000-419000 $188.00
STONC Mar1DN FEE - R5i<iZ1) '101-000-241-0013 $21.53
CMAD O ME, 101-000-42 �-OW $20100
INMA311R UrURF M. 225-(}00443-312 $4,810.16
PR1-VSE PLAN 1.0'1-000-441,-345 $25.00
ART LN .PUBLIC PLACM - Row 701.000-255-000 SM.29
�O/ SUI�-'.I'OTAL C:ONS`TRUMON AND PLAN CIaIECK
LESS RRE-PAID FEES
$7,617.66
$0.00
FFe T WAL r, EES DUE NOW
$7,617,66
;PERMIT
2 3
1996
RECEIPT '[DATEY
BY
DATE FlNALED
INSPECTOR .
INSPECTION RECORD
f
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
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 CITY OF LA QUINTA
°mow . BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
`� 777-7153
Owner T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9602-0.08
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
48-605 CAPISTRANO WAY
JOB ADDRESS
SFD PLAN 2 LOT 116
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL ,
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL AB VE HAS B EN-SJQNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
I
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
I
J
COVER NO WC
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
SEWifR SEPTIC TANK
ELECTRICAL
PLUMBING
FINAL GAS TEST
H EATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
,�� TURN ON UTILITIES OR OCCUPY BUILDING