9602-010 (SFD)P
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LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect.
7 2A' 8 �,,qi 31 i 97
License�I a U�'. Gass - Exp'
Exp, Date_
Date,)J)3 /V (' Signatureof Contractor , )%
�— 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 df 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 Labor 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 section n�I_d not.be completed if the permit valuation: is for $100.00 or less).
O I certify9441in IEWperformance of the work for whIc1 A i' 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 1 should become
subject to the workers' compensation provisions�of"Section 3700 of the Labor
Code, I shall forthwith comply with those proQis ons.
Date: r7 /1 1 lCi Applicant r t✓ t � '� 1
IN 4
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 ISE
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.
1 '� f •("
Signature (Owner/Agent) i Date Z�
A`°"
BUILDING PERMIT
PERMIT•
94602-01111)
DATE 2% I(9L6
VALUATION�+�����
LOT 113 TRACT 27.,0
JOB SITE ADDRESS
APN
48-610�;:APIS'I<CdANO WAV
446- 011
OWNER
CONTRACTOR
STIA:RKS CONS'(RUC11ON
1".t). DES'PIRT M+,'TEt.,i.;PMENT LP
101 WALSTOEN' RRI )CM RD NO.
P.O. OX 1716 =, - ..
i.t\ fjT).CN.t; k CA 92233
LA. QUINTA CA 9253
(619071-041. CRIX 2996
DESIGNERIENGINEER
(60)771-19411 c941
USE OF PERMII -Ijq LIZ �'t1.1`'1I.LY DWELLING
I.Z. NCHO Lis, QU1,N'1'A
f`Is'f R) LA. PLA1d 2
FEE DESCRIPTION
FEES
i; US1i.110M4,:UAISTRUC ION 2,W2,00 SF
PORCIVIIIA 10 11:10) SF
GARAMICA ZPOI T 685.00 SAF
ES A'1! ED COST OF CONSTRUCTION
215.314,313
PERMIT YEE SUMMARY
PLAN C.'gW,14. F -FU 1'01-000-439-319 $979.M*
craNti"l"tt(1C�i"tz�x:t cel: 101-000 41R-OOa �I;c>~1�:4
iVir 0 ANICAI PEW, 101-000-4.21-000 S442.5u
UE,CTR-tCAL FEE' 1014100-420-000 $197.22.
PLZJ"IM1Yhit. 1111-000-419-000 $188.00
S`PONO MOT 1014 IFTM -1 SID 101.-000-241-000 $21.53
ORMA 140 FEE 101-004-423-000 520.00
INFItANTRUCTU12.t:,F':F_s 2,25-000-193-342 $4,8.10.1.6
PRKI(ST? PLAN 101-000-441-.345 r2S.m
ART IN:PILIALIC PLACES REST13 701-400-255-000 $288.2
0
L I jail. Ct":f I1 MUS, ITON AND PIAN CHECK
S,7,6166
FEB 2 3 %ESS PRE -PAID FEES
$0.00
1996
i TOTAL T'1r::, NITC FE"t ;DUI: NOW
5�,637.G6
y
a.
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:
r
'C
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
�.� 777-7012
.. INSPECTION REQUEST LINE
777-7153
Owner T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9602-010
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-610 CAPISTRANO WAY
SFD PLAN 2 LOT 119
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 SIGNEC
CONCRETE SLAB -
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
0
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBIN_
ROUGH GAS & OAS TE
HEATING & VENT -A/C
FIREPLACE
ROOF — U
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 L�
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL/—
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
CERTIFICATE OF COMPLIANCE
Date 2/13/96
No 14145
Owner Name T.D. Desert Developoment
No. 48610
City La Quinta
Street Capistrano Way
Tract # 27840 Lot # 119
Type of Development Single Family Residence
Comments
By
APN # 646-390-011
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 `_ Telephone= 771=?=941
1.
Name on the check
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $4,423.84
Check No. 7881
Signature l A l 0 1 AA C) ALA
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