9601-070 (SFD)LICENSEDCONTRACTOR 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 effecdt. 674074 B ,w 7/3119A95,,,
LicenseE # / , • Lic. Class Date-,
fi
Date.;.t,„�.! !S`! $ignatureofContractor !� 1 r/ \ �`
OWNER -BUILDER DECLARATION y
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
() I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
(') .I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signatureof Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of,perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued..
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance_ carrier & policy no. are:
Carrier Policy No.
(This sectiopjQfgdjr;o, JV completed if the permit valuatio!1#Jo9$,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, l should become
subject, to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthinrith comply with those provi-Jont
Date: ' A. 114 (..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 information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby'authorize representhtives of this City to enter upon the
above-mentioned property for inspection purposes.
Signature Owner/ ant/ 1 Dafle 1 ” r G`
( ) —
AL"
BUILDING PERMIT
PERMIT ,.67,
DATE r ;lr1I719
VALUATION N31.3JX1. 53 LOT a
TRACT VYY -1
JOB SITE ADDRESS' M1!5 �>tA � .. C1.A.RA
APN 649-a614l-l�1DI
OWNER
CONTRACTOR
SPARKS CON„�TJKIJC'i' GN
'.D. DESEUDEVE4C)aP"OEINI'T LP
J 101 titr>'l.i.:S 'Ii�ibGl�
t>.C?. 3fi� 111
{ LA01JIi�'i't'1 CA _02.253
1,64 t lJ11`i'('A (A 92253
(619:1'171-.1941 CBLf# 2990
(619)7-71-1941
DES16NEFVENGINEER
PPKeIa.'.I±X-CRA''f4DFJ, L, INC.
_ 2672 BIRTC77 S.. M.
USEOFPERMITj1 (tib EFAMULYDWELLINU
w
Y r 4 VIP POP V qT r A Y) 11n rl,r WA'!_+
RANCHO LA QtiIRM y
PALACK) PLAN
FEE DESCRIPTION
FEES
CQ 3' -0M CONST tU&rto N 3,822.00 1.k ^;
POPLCHIPATTO 130.00 SP
GAItNOEICARPORT 71:'666.60189F
1r STMAITM COSTOF CONSTRiJ('"UON
: 33,:181.40
PE9eAUT.i+'EESiJ} K� &Ri''
V-1 o"Im owrk- PES; J,01 -000-439L318 -&I,1,3S.m
CONSTEZT CTION'FEE 101-000415.000 t1,334.50
MhCf1 MCAL FEE, ' 101-000-421-0610 $137.00
ELF.C`1R[CAL FFE 101-000-420-000 $227.09
,:PtUNl3TNG FW, '101-A00-419-000 $7.0f.00
STONG MOTION FM - .RESID 100-000-241-0610 $31.3^
(NIADIN G FM 101-M-423-000 V20.00
11,11 RJ1.STRUC`lM11FEE 225-M 44'_�P2: �.Oi10.G0
PRECISE PLAN $25S
ART IN PUDLIC I•'1.ACES - RE -S= 101 -000.255 -WO $532.95
o : CC1T�I;L CONS"a:IIC,°i oNy. Aigri PLAN cHr1 I'.'1C
LESS .PRE4JAID TES
$0 6667
E�
2 3 1'�7i” �'1a:id11'1.1'F �+'1Cl• S DUE NOW
S%703.16
,99
M
RECEIPT
DATE
By
DATE RNALED
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 8 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 LinesHeater
21
Final
-Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
eSewer 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
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 APN # 549-400=002
No. 14158 Jurisdiction La Quinta
Owner Name T.D. Desert Development Permit #
No, 79015 Street Via San Clara Log #
City La Quinta zip 92253 Study Area 123
Tract # 27952-1 Lot # 2 Square Footage 3822
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 -,xempt 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 3,822 or $ 6,573.84
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 Developoment Telep hone 7714'041
Name on the check
By Dolores A. Ballesteros
Superintendents r` \
Fee collected /exempted by Pauline Pearson Payment Received $6,573:84
n Check'No. 7881
Signature ` (lc a s ll e c l �QQ�1 A LA/A
Collector: Attach a copy of county or city plan check application form to district copy for all waEvers.
Embossed Original- Building Dept./Applicant Copy 7 Applicant/Receipt Copy - Accounting
PITY OF LA QUINTA
OfBL4DING & SAFETY DEPARTMENT
�O 777-7012
INSPECTION REQUEST LINE
�C 777-7153
Owner T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9601-070
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-015 VIA SAN CLARA
SFD LOT 2 PLAN 2
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 SUGNED
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 7
GROUT ❑ 4' ❑ 8'
FRAMING .
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOYE HAS BEEN SIGNED
DRYWALL INTERIOR `
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FI
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUP,E NUMBERS
;'3191 COMPLETED
TEP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING