9609-071 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
. 0ofessionals Code, and my License is in full force and effect.
License #, Lic. Class Exp. Date, .
-' `'Contractor,.
Date � Signature of f
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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 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.
`'9"A1'.Ii FUND 1.37109$94
(This section need not be completed if the permit valuation is for $100.00 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,b come
subject to the "workers' compensation.•provisions o'Secf on 370Q,of the Labor
Code, I shall'forthwith comply with those provisions.
Date: ''r Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application'`%
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under. or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize represe,ltatives of this City to enter upon
the above-mentioned property for inspection purposes
Signature (Owner/ ggnt)� Date��
t
/�/�`/y BUILDING PERMIT PERMIT.N��„� CONTROL#
410 4
DATE � VALUATION �A.$yl`'�ifl1; ,40-! LOT LO' 70 TRACT
i3OO t,A Q0 IN ISA JIM
APN 6j414-3741-001.0
ADDRESS
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SPARKS CUNS"fiRUC" ION
RU BOX :i'710 .
79295 RANCHO IA QUINTA. M.
1..A QUfWrA C'A, 92233
LA QI..11 YA. CA 92253
771.19411
CUR 2"6
USE OF PERMIT
sINGIA RA1AWN
RL AN « TUR ,AZA.
11MOT 'IeW MFLWT Ard ART iN PUBLIC PLACW CRWIT OF
S^Z26.02 IMI AG "S.Ef°.,'VIWF WT111 C0NMIlUN1TY L EVU.G1'N1ENT
CUSTOM CON'8q'Rt.1C'1.`ION Z285.00 3F
! OP—a14"ATIO 11.5.00 SF
CFARA(. WCAIJ-%0IZ 535.00 SC
1191M>t: T IVE'R StIMNIARY
PLAN ,:,HECI•: F'SI3 $795.62
WNSTRUC;TIoNF[if-, 101-000-419+-000 39S,.00
Ml1{{'lAN CAL FF -0 1011-000-421-000
111AX I1:.ICA1. FRE 10170M? -420-000 S1'71.0�
1:'1<1.fN1.B1NIG FM 101.060.41.9-000 $160.00
S1'i♦ NG MOTION FLE - RUSID 101 -00€} -2111. -WO $19.04
U t2, )INCITE' 10140JI-4,23-000 $20.00
'IAf RAS'f}tV(7rI]1tIR l! i3 22.5-000-443.342 S4.?ri9,",9
ART 1N: f'iU-11'r' PLACES - q SU: 70.1.000 -254 -OW $226.02
ARTIV :I?i��I�1.IC PLACES - RESH,'' 7014000-V55-000 -V26:02
SUB-'ftYr lL CON' MUC I`iON AND PLAN CHECK
$6,711.05
LESS PRE -PAID FEES
4226.02
RECEIPT
DATE
BY
DATrIN ED_,,?
I INSPECT /,(
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 Wali 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
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
Final
Utility Notice (Perm)
i
Owner T.D. DESERT DEVELOPMENT LP
ContractorSPARKS CONSTRUCTION
Permit Number 9609-071
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-910 RANCHO LA.QW,- T. !A DR
SFD PLAN 2 LOT 70
FINALS .
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
I. 9� TURN ON UTILITIES OR OCCUPY BUILDING
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
�.
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALLABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
�.
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ g'
FRAMING
INSULATION
4if
PRE -ROOF
/,z -
COVER NO WORK UNTIL
ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
oZ ^
EXTERIOR LATHPOOL
PRE PLASTERENCE
nz-�
& GATE
SEWEpt SEPTIC TANK
I n _
FINALS .
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
I. 9� 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 10/9/96 APN # 646-370-009
No. 149.19 Jurisdiction La Quinta
Owner Name T.D. Desert Development Permit #
No. 78910 Street, Rancho La Quinta Dr. Log #
City La Quinta zip 92253 Study Area 123
Tract # 27840 Lot # 70 Square Footage 2285
Type of Development Single Family Residence No. of Units 1,.
Comments
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 1.84 _ x 2,285 or $ 4,204.40
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
Name on the check
Telephone 771-1941
By Dr.. Carol McGrew
-Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $4,204.40
Check•No. 9453
Signature Q \�. Q AA6)a,6-A_
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