9601-031 (SFD)LICENSED CONTRACTOR DECLARATION
I heir y 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 g
License # Lic. Class Exp. Date .
Date:.)11 , ./„/� Signature of Contractor ._,
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).
{) 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: '
O 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 sectjgn nge4..(9tq?p completed if the permit valuation(s;)90$,1.Q0.00 or less).
() I certify that in the performance of thei 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 thatif should become
subject to. the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those�rovisions.,,^� .
Date: _:,1. !"A5 c� Applicant'
licant
>�
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and .Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each, person upon whose behalf this application is made & each person at,
whose request and for whose benefit work is performed under or pursuant'to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
-I certify that I have read this application and state that the above irformation'is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection purposes. f J�
Signature (Owner/Agent) ,' „ i L✓ Dab �J 2 ' 91:1
ALC.
rs
BUILDING PERMIT
PERMIT 6,),) .
r
DATE 1 `vo
VALUATION 4f. 9-)-h1J
LOT TRACT 1: -1:•
JOB SITE ADDRESS 7.9-0,25VIA SAN E:I..A: A
APN "9400-03
OWNER.
CONTRACTOR .
SPARK, 'CCNS';r`(i,W r10N
7'.17. nF S 1i '12i 'LiD.1,hI 1�Ii" :R> ,
10 1. WtU.:� N BRIDGERD NO.
P.0. 0X.1.716
LGA QUINTA CIN. 92253
LAQUTN A. CA 52253
(0I9)771-1941 C;BL# 29Jr
{619)771•4941
' DESIGNERIENGINEER '
7'H"T?EK-OR/1ME3 LL.. INC.
23672 X1.1 X •�}S-` ,, 0XL
USE OF PERwtil rvj ; Lk s'.FiJ `d ' L1Wb ',L :.1t+U
PAi_AC.10,PLAN i
- �,KS •r
+ FEE DESCRIPTION' r
FEES
4:1�63'l.'G'1M6: �:•CJJd.',i)'#:t:f;Y(y'°x'r(7t�t �,�tf�$.O(i :l:.N
P6P,CF•T/PATTO »S.iIO 5
GArtAGWCARPORtT Ct08.L<I? SF
fS IWfED COST OF C:Ciiy `fi'[di1CTt`7N .
86,295.84)
1 ERMff FEE' SUAIM44.RY
PLAN CF�'C.K t~Et. 101-000-439•11$ 81,06S.95
CONS`1'.f2UC'1'IONF'FE 101-00041€fy000 $1,294.00.
MIRO1•IW16Af M-1 101-000-421-00.0 $143.310
IYLECTMICAI, FES 101 -OW -42.0-000 12:13.44
P11TUMF4iNC b -FE, 101-000,419-000. $2060)
STONG X10 TION, INK - KSID 100-000-241-M $28.63
Ok AiDIM F VX1 $213.0
n*-, i;ASTRtfc,'UFU'..,*i;- .E, 2:25-000-41.43.-342 6.ht .Q4
mc. 1'GtlN 101-000-441345 $25.00
TAL CCh..TfItUC1TION AND PLAN CHECK
$9,,462,26
Fc r,�sS PRF p.A.j17FF.Fs
$6.06
3 1996 TOTAL PERM.'f E S 1) opt; NOW
594462,26
• s
F�
RECEIPT
DATE
BY
DATE FINALED
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
Verits
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 A"
Final
_,e
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
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 # . 549-400-003
No. 14159 Jurisdiction La Quinta
Owner Name T.D. Desert Development.Permit #
No. 79025 Street Via San Clara Log #
City La Quinta Zip 92253 Study Aurea 123
Tract # 27952-1 Lot # 3 Square Footage 3465
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 .ori-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 3,465 or $ 5,959.80
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 Develo oment Tele�6ne:�. 71-
P sal ^'
Name on the check
.1.1.. �.
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $5.959.80
Check No. o o
Signature
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
s _Q'CITY OF LA QUINTA
Ivo, ~ .b B'LDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
is
777-7153
Owner T.D. DESERT DEVELOPMENT
SPARKSCONSTRUCTION
Contractor
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
ARA
JOB ADDRESS
SFD LOT 3 PLAN 1
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 SIGNED
CONCRETE SLAB - (�
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING ."
ROUGH GAS & 6AS TEP
J 7 7 -
HEATING & VENT- A/C '
.FIREPLACE
ROOF Z (�
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING -
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNER
FI
ELECTRICAL
PLUMBING
FINAL GAS TEST
Hr,ATING - A/C
HOUSE NUMBERS.
,JOB COMPLETED
'1 EMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
T 1P 1 P..1 . 1 It __ f --. - m. 111