9601-089 (SFD)LICENSED CONTRACTOR 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 effect.
.,;
License # , ,r Llc. Class'
Date 47 f�SignatureofContractor /' V .tet
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 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 sectidfiA dtn6V a completed if the permit valuatio0s;fo&$400.00 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 Section 3700 of the Labor
Code, I shall forthwith comply with th, dgikprrovisiolns.
Date. 0' D 111 lopoicant
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 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 relatingto the building I
construction, and hereby`authorize representatives of this City to enter upon the'
above-mentioned property for inspection-purposes.
Date 7 Ja,
Signature (Owner/Agent
A""
BUILDING PERMIT
DATE If A.11710
VALUATION
LOT .14 TRACT
JOB SITE ADDRESS17-040 VLA SAN C;�.e'�.Rcs
t�►
APN
OWNER
T.D. DE, .R'T IDEEV.ELO;PME7`J'1'IR
P.a. BOX 1.716
CONTRACTOR _.
1,01 '1>'m„s'mi 6vi2 or!.'RTJ tio.
Ltd.(; Uil rA--A 92.2'33
ire#ii�iJ!'NF A. CA. 92253
(619V11-19419 CBL# 2996
DESIGNERtENGINEER
'23672;SfR`%+ if : DR -
L .F0 RF9f. Cti.92630 (71433-1,!
USE OFPERMITi .- Ci _rl ''f sM1.: , r4.43
►�a� .LAQUrINTA
PA.t:ACtO PLAN 1.
FEE DESCRIPTION
FEES
isatv�1:'C3��i L?a1tvS'I`!�:U�t':!i>N ;��a65.vu Lt�
PdRCIT/PATIO 335.00 SF `
i<ARt1CidCAlOitiSit
ESTIMATED COST Of CONSTRUC- 5'iON
29612 5.84) '
Iy1,ANC`13FC::KF 1'
CCtF1r','MU>;:T;C3N V=, lot-COM-4:SR400
ME `iII&WIi"AL FEE- 101-000-42i-000
VJ,1✓,:,1'RtC.aU: FE, f S213:44
I'!,[irurxl�rf t+? r:ill.-�}tt(f-419-(�(lt9 $7A6.00
S'ron,a f<40:1'ION 1=1" � - i2 SID 100-O 241.000 3208.63
GRADING ME 101-000423-060 ���►:Vt�
�l'itA 'l. uC'TU}4F_ I 22_i-00()-44_%-342' $6,000.00
7 Q E -011n.44 I -145
AU IN -I Q LIC iavAM3 -1"rl it 1465,74
SUD-'1`f>TAJ. CON11STRUCTION' AND PLAN CHECK C.
ESS PRE -PAID ICS
O
$?,do2 a.o
aii:i}
F TO T A_L. P� °BRAT � I+M,S Ipk►U1°IOW
� Ee 2 3• 1996
°�,4Qi2.
RECEIPT
l)ATEe
BY
DATE MAILED
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 & 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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Viewer 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:
U
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/13/96 APN # 649-400-021
No. 14162 Jurisdiction La Quinta,
Owner Name T.D. Desert Development Permit #
No. 79040 Street Via San Clara Log #
City La Quinta Zip 92253 Study Area 123
Tract # 27952-1 Lot # 21 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 ,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 3,465 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 Development � =Telephone• 771-4'14'
Name on the check ' {
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received " " $5,959.80
Check No. ` 7881
Signature 01\k A (01',,,,. a � � A l �/ iA XW
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
r—
CITY OF LA QUINTA
o, -` `' BOLDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
Gv �. 777-7153
r•�l
Contractor SPARKS CONSTRUCTION
Permit Number 9601-089
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-040 VIA SAN CLARA
SFD LOT 21 PLAN 1
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
AROUND PLUMBING
PRE-GUNITE
AO 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 & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOYE HASEEN SIGNED
DRYWALL ANTERIOR
EXTERIOR LATH _
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
w
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING