9601-092 (SFD)�I
LICENSED CONTRACTOR DECLARATION
!'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 effect. 674074
License /#/ % _ r Lic. Class �— Ex.
rgat
—�e /
Date �j�fi ':iY" Signature of Contractor I ; �/ Y
OWNER -BUILDER DECLARATION '
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).
_( )=-1 =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.
(This sectionln, completed if the permit valuation`is,fori$: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 become
subject to the workers' compensation, provisions of S_,eetin'37'60,of the Labor
Code, I shall forthwith comply with those provisions �.
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
fora permit subject to the conditions and restrictions set forth on his application.
'!''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
correct. I agree to.comply with all City, and State laws relating to the buildingy
construction, and hereby authorize representatives of this City to enter upon theme°
above-mentioned property for inspection purposes
Signature (Owner/Agent)
�� � - i� Date
E"x ,t/ ,S 7 /t"Oee 't_ , �,. c_. �"�J! `•ty
ALCM
-
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BUILDING PERMIT
PERMIT§,6;)1.wP92
DATE II/I IfYti
VALUATION
LOT - TRACT
JOB SITE ADDRESS y ,..
9-0.1�it AflPkr
VIA S
APN
_ `l.L+i•`ARii►
OWNER S' .e`.
CONTRACTOR 1
t
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T y� DYE C�3 T�
I..l.i. L�i��i•?.G:I-w •i,�ii Orn,:�+e®i�,iK .:ilii i` '
'101 �'1�X ALM .t t. k� �d"J' .J. ..
LI�C;�.IJ`tN'I'A. w "CA, y.'Z.2?� ..
� {61:t?7;1..to�� r'1�.1,#� 2906
i DESIGNER/ENG[NEER
_GrIR72SKrL�v����r�N &L. INC..
236p i i�g\1�1�i Lid f4
USEOFPERwTe1l,;..e i•ii _Ad!1•.Y *L)W �..It,.ijI{� Qi
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i. e1i�F re,Fe?::: t d•!i1 �S�t, cf:IriaiSiA7 s
16NN- ,iCG :I X QUtNTA
P AI:AC10 PLAN
} FEE DESCRIPTION
FEES'. -. 7'::
L 5':1.'C5£1A 6.(J1d`3l:.RUQ1-ION A s"?,:: t.0 L•.H
J3WIMT,Alno '180.00 ;if'+ .
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P MT FIR
ER 1F, SUMMARY
t'Jt? N C ! 1 9^6.', t?1= 101405-4 5.311
�
CCtNS�'.[ZLG•TicJl�'�1� 'IE:Q-t7Ut}..4•l.�-(JQft '~ $1;'�Sg.Sti
.
.Ik'ltCH AMC!`,L i IX. tt .i -i1(}()^ ?j*!) � 'i, 90i.60
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317M.09
.101-000-420,W) b� aD17....� Y .09
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C "2ZMJm3 t%c $2f) -of)
-
i�i1%tiff FF 225-000443;,342 eri;�N3(i.UCi
1��}�f":!'CY ;P)FA1J 0. -000-44t4,15 �2y.i)i7
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ART A"IC 11rA05S -,RJISi% 7L.t-000-:2.i5-0110 35?2.9
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rpt.?,�(:►� t;
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LE SS PRFE-PAII)FEES
$0.
�3,9
96
RECEIPT
DATA
BY
DATE RNALED
INSPECTOR ;•
0
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
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
e
Final
Utility Notice (Perm)
't
I
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
T.D. DESERT DEVELOPMENT
Owner
-SPARKS, CONSTRUCTION
Contractor , w,
Permit Nuinber
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
.79-010 VIA SAN CLARA
JOB ADDRESS
SFD LOT 24 PLAN 2
TYPE OF'INSPECTION DATE INSP.
FOUNDATION & SETBACK
'FOOTING STEEL
MAIN GROUND SYSTEM
*GROUND PLUMBING (;P,
RE-GLINITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNEE
CONCRETE SLAB
A,
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 6�124;
GROUT 0 4' 0 8'
FRAMING -
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR X. -w-
----EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
F'NALS
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
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 # 549-400-024
No. 14165 Jurisdiction La Quinta
Owner Name T.D. Desert Development Permit #
No, 79010 Street Via San Clara Log #
City ,La Quinta Zip 92253 Study. Area 123
Tract # 27952-I Lot # 24 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 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 1.72 X 3,822 ' or $ 6,573.84
the property listed above and that building permits and/or Certificates of Occup�t dy for
this square footage in this proposed project may now be issued
Fees Paid By T.D. Desert Development , �F�.`' TeleFho}nem 771-19.41
Name on the check
By Dolores A. Ballesteros-
Superintendent
r
Fee collected /exempted by Pauline Pearson Payment Received $6.573.84
nn Check No. 7881
Signature R�'V' kAt A ,a cyy✓l
C
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