9601-142 (SATT)U) F LICENSED CONTRACTOR DECLARATION
•
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
oW - Section 7000) of Division 3 of the Business and Professionals Code, and my
License is in full,force and effect.
W r License # r' Lic 7t;lass ��"1'f97
Exp. Date .
I• r1_ Date .=�1�./!t Signatureof Contractor
{
6 Z r, r '-
cro 0 OWNER -BUILDER DECLARATION
J IU I hereby affirm that I am exempt from the Contractor's License Law for the
0_ 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 Signatureof Owner
N
rn WORKER'S COMPENSATION DECLARATION
d Q I hereby affirm under penalty of perjury one of the following declarations:
g Z () I have and will maintain a certificate of consent to self -insure for workers'
In �< 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.
p J J ( ) I have and will maintain workers' compensation insurance, as required by
C0 Q U Section 3700 of the Labor Code, for the performance of the work for which this
C5 U permit is issued. My workers' compensation insurance carrier & policy no. are:
CL Lo H Carrier Policy No.
�f Z (This section d. , of a completed if the permit valuatio is f&$100.00 or less).
r ofV'ir t�$v ' i
OD � () I certify at In {he performance of the work for which Mils permit is issued,
Q I shall not employ any person in any manner so as to become subject to the
_l workers' compensation laws of California, and agreeltha If'kshould become
subject .to the workers' compensation pr visions o'f Section 3700 of the Labor
Code, I 'a16 forthwith comply with those!provis ns. E
Date: )Ab 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
44
whose request and for whose benefit work'is performed under or pursuant to
any permit issued as a resukof thq appllcatio6agrees, & 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 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 inspectibn purposes.
Signature (Owner/Agent) I -'/ Data "X ; ✓aj
A"'
--
BUILDING
PERMIT
PERMIT•,4,
:A-�Z
DATE �� ���.
VALUATION $1&1118-2�tf
LOT 2 TRACT .27815
JOB SITE ADDRESS
APN
4&040 VFt k VAL LSA.:)€ TA
64'_3_310-4102
OWNER
CONTRACTOR
�
SPARKS C(?1�1�1'R.€JL"'lii(�N
T,13. OF f;R'1.':DIrVELOI?hR1r1tS7' LF
101 WALSTONI BRIDGE RD NO.
P.O. BOX 1716
t, LA. QU NPA C& 92253
LA. CjWNTA CA. 9225.1
(619)771.1941. C13L# 2496
(619)77t.1941
DESIGNER/ENGINEER
PFK qP kms..-CR.AN`D.DX. MC.
^3677
•t36 77,n iv li C�Z vn
n Y/rte R� N Al y1•! -
*r C �
USE OF PERMIT+ -I r 't�to X`1171,
Aim iLIE �4AIs%:1`1
92636!W!
L! .Mr � W EST; A. `I
1tANC.HO LA QUfN't'A.
CALS1'PAS I3iJCaL Y. PLAN B
FEE DESCRIPTION
FEES
CUSTOM CONS'11RUG.1'1G2J t,967.00LF
PO`R.Cki7PA:ri.O 240.00 SF
.
GARAWCARPOWr 447.00 SF,ESTIMAXEM
COST OF CONSTRUCT MIT
PERAM i 1:~ EE tiUMNIA.RY
PLAN CfECK P43y, 101.-0110-439-3.9:8: $71:3,98
CONST 12"t1MONFEU 101-0004M060. $870.50
6M- 1.A; 1CAL 1�4 1.01 -Ann A. -I'1-013 ..E
1sL6C'TRf(;Al;::F'1 F 101-000-420-000 $1,41.29
12r,tJN11 iN( F FI s 101-000419-0M $1. ►,nNJ
STOrNal MOTION FIES - MIMI) 100.000-241-000 $16.521
0RA'DIN0121 3 101-400-423-600
.tNFXAS'rR C7LIRE FEE, 225 -WO -441-342 $3.544.79
.A.P,T !N ,PCs13LK3 P1,ACES -}SES:@: 701.1-000-77-000 elf;?.4h
/n\ $L7Er' .ONS!"Ri,i� ON. AND PLAN �.14FCK
$5,795.04
U TRESS PRE -PAID HERS
$0.00
FEB 14 1996 TOTAL PERMFr FEES nur NOW
S5,T*.04
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
a
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 6
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:
'
T
a
s CITY OF LA QUINTA
Ivo, BUIj ING & SAFETY DEPARTMENT
R4 `� 777-7012
INSPECTION REQUEST LINE
[B 16 `� 777-7153
Owner . ,,IffD: fiSESERT DEVELOPMENT
SPARKS CONSTRUCTION
Contractor 9601-134
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
. 48-020 WA VALLARTX
JOB ADDRESS
SFA PLAN A
TYPE OF INSPECTION DATE
INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE
S BEEN SIGNED
CONCRETE SLAB
/
JOISTS & GIRDERS.
ELE TRICAL GROUND WORK
� C S. ( C
DO NOT POUR CONCRETE UNTIL A L ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
-`J
GROUT ❑ 4' ❑ 8'
FRAMING -
INSULATION "
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS NE SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK 7 0, -
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