9601-164 (SFD)P. `,\ ' LICENSED CONTRACTOR DECLARATION
\I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
r W Section 7000) of Division 3 of the Business and Professionals Code, and my
C) O �
_ License is In full force and effect. 674074 7/ 1197
n WLicense # Lic. Class ., Exp. Date -
Z^ Date V/_�,->• �SignatureofContractor
.� o� OWNER -BUILDER DECLARATION `
_j IU 1 hereby affirm that I am exempt from the Contractor's License Law for the
IZ 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
�
Date Signature of Owner
N
O rn WORKER'S COMPENSATION DECLARATION
aQ I hereby affirm under penalty of perjury one of the following declarations:
Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
LO H 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
00 Q U Section 3700 of the Labor Code, for the performance of the work for which this
O V permit is issued. My workers' compensation insurance carrier & policy no. are:
M rn Carrier Policy No.
I. z (This sectj9PinQptgWe completed if the permit valuatigrfjfQg$hg0.00 or less).
N O () 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
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section..3700 of the Labor
p a Code, I shall forthwith comply with those provisions.-*" -^^�
Date: ,A / i r r° (,r 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.
1 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 inspe`ctiioonppur oses.
Signature (Owner/Agent)
ALC0
BUILDING PERMIT
I PERMIT' ,
11fs0ii•2b4.,
DATE
VALUATION .� ,iiJ, i�l.:�fs LOT .1. 115
TRACT. 'Z'tK4U
JOB SITE ADDRESS
AIN
OWNER
CONTRACTOR .
SPARKS CON1,;r? TJ1CTlON
T.13. D SERTOBVE OWYN'TLP
79-295 .,P ANC.-tlO f.A'.gUl'NTA DR-
Ro. BOX 1716
LA QUINTA CA 92253
LA QtJTN'i'A.. CA 9225'3
(i:i4)77.1-:1941 C 8L# 11.996
(0119)371-1,941
DESIGNER/ENGINEER
USEOFPERWV1 .Ci ' 1-1 . EY LJWF,,LLINU
RANCHO LA QUlNTA ,
TfU,MA%A PLAN 1
FEE DESCRIPTION
FEES
CUSTOM C'0N.,;'r9UC V.TGN 2,231.00 L
PGftC'H/t A'r10 1.70.00 Sri
0ATiAGMARPORT 486.00 SF
ESTIMATED COST OF CONSTRUCTION
18.5, ;,1 550
PERMIT FEE SUMMARY
PIAN CkiWX iFEF 101-00(,1.439-319 $?74.54
CONSTRUCT1014 PER, 101 -OW -418-000 $940.s¢
:t1!tECRAN1CA€. F S 101-044421-000 $90.50
E1.FsMiC AL F731�. 1014000-420-000 $16T81.
P.t1tW- i3rNQ F ,17 t011-000-419-000 $142.00
37'01 O IN4C TION, M - R, SID '100-000-241-000 $18.56
Cad. ADINOFh1r 01 -WO -41.3-000 820.00
JNF ASTRUCTFU11E'FEk 225-0001-443-342 $4,124.71
ART IN MIMIC, PLACES - RP?SM "711(:-1,00-25.5 000 $21:195
SUBYf'07'AL CONS°TEtUC7110N ANIS PLAN CHECK
LESS FRE -PAID FEES
$6,500.57
$0.00
Q
FF IOTA1.REIiiliT FEES DUE NOW
K500.7
B 2 31996
�I
RECEIPT
DATEi''
By
DATE RNALED
INSPECTOR �7
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:
a
s CITY OF LA QUINTA
,BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner
Contractor SPARKS CONSTRUCTION
9601-164
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-620 CAPISTRANO WAY
SFD PLAN 1 LOT 118
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 - G
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS AS TE
HEATING & VEN - C
FIREPLACE
ROOF
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 - y
POOL PRE PLASTER
NCE & GATE
roEWEfeSEPTIC TANK- A-/
FINALS
ELECTRICAL `
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1195 TURN ON UTILITIES OR OCCUPY BUILDING