9602-009 (SFD)u% LICENSED CONTRACTOR DECLARATION
N (n I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
, W J, Section 7000) of Division 3 of the Business and Professionals Code, and my
C) C) M License is in full force and effect.
N W Citas4 4 Exp. /'�7/-J/97
N W ^ License # . Lic''.�'� tK ,.- Date• �
nr- Date7I Signatureof Contractor
a,O� ' 1
Co I_ rn OWNER -BUILDER DECLARATION V
J W G I hereby affirm that I am exempt from the Contractor's License Law for the
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
V) Date Signature of Owner
N
Q rn WORKER'S COMPENSATION DECLARATION
d Q 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'
r O compensation, as provided for by Section 3700 of the Labor Code, for the
K W U- performance of the work for which this permit is issued.
JJ ( ) 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
J U permit is issued. My workers' compensation insurance carrier & policy no. are:
1LOCarrier Policy No.
? (This section need not be completed if the permit valuation is for $100.00 or less).
r- CY () 1 cdWfj4fhatlimithe►performance of the work for whi60thii PoWmit 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
Code, I shall forthwith comply with thoserprovisio s..✓ "-""`�..--
Date: , ��/„ Applicant y -
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 informationis
correct. I agree to comply with all City, and State laws relating to the building,71
construction, and hereby authorize representatives of this City to enter upon the
• above-mentioned property forinspectionpurposes.
Signature (Owner/Agen> f° 5 1 ' fl Date ! x r "als
ALC
BUILDING PERMIT
PERMIT•
I
DATE V 1/46
VALUATION S215.314.3Q LOT 117
TRACT 27940
JOB SITE ADDRESS
APN
QL6JUI CA PISTRANO WAV
I 64&3qft_41(W
OWNER
CONTRACTOR
SPARKS CONEWRUCTION
- i.D. �ESl ryD+YF11Opii �7X1,P
101 WALSTONIBRIDGE RD NO.
R0_ BOX 11716
LA QL1hVrA CA 92253
.LA. QUINTA CA. 927-53
fit 1+1771 _ I (iA ogl A -)004
DESIGNERIENGINEER
{s619)771.4941
USE OF P"'ISINGLE 4'AMILY i7 V11LING
RANCHO LA f,1UINTA.
'1TA PLAN 2
FEE DESCRIPTION
FEES
(:11STOM C:Ct;NSIULIC t'fON Z572.00 SI~
PORCH/PATIO, 115.00 SW
G ARAGWARPORT 685.00 SP'
ESTIMATED Cass T OF CONSTRUCTION
215.314,30
PERMIT FIS'E SVIkIMARY
PLAWc,WXX FER tQ!-000-439-315 $879A6
CONSTRUCf (ON FES 101.0004t"00 $1,044.50
_h&6 HANICAL VF1, 101-000-421-000 X142.50
0.161- MCAL. FIM, 101-000-420-000 5197.2.2
KUN113TN<;
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 Wail 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
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
_
`6'
'r :11E !' _
Of
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-71.53
Owner T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9602-009
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACE
TRANO WAY
JOB ADDRESS
SFL) PLAN 2 LOT 117
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 SIG
CONCRETE SLAB 1[.
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGs
ROUGH ELECTRIC
ROUGH PLUMBIN
ROUGH GAS t6AS TES_.
HEATING & VE C
FIREPLACE
ROOF G 1
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 �f
POOL PRE PLASTER
ENCE & GATE
EWER EPTIC TANK
FI
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
tR-OVE �Po4OVALS DO NOT INCLUDE FIGHT To ,.