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9601-072 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm`d at I am licensed under provisions of Chapter 9 (commencing with Section 7000) of'nivision'3;of the Business and Professionals Code, and my License is in fuliforce andieffect. �r L� ;/31/9: c�CsLicense # as� Exp. Date Date AA f SGrlatureofCcntractor -.L� 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). O 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: ( ) 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 sect'eed,r�it.b�e completed if the permit valuation �i,syl,%r y,l00.00 or less). () I certify at 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�shA forthwith comply withrthose 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 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 representatives of this City to enter upon the above-mentioned property for inspection, purposes. , Signature (Owner/Agent) Datel I ire ,y A"' BUILDING PERMIT PERM'T9601-0-x DATE 1/7196 VALUATION LOT TRACT f JOB SITE ADDRESSAPN 79-1)315 V#A SAN CLt1.a8A . 6()4.406:604 OWNER j -CONTRACTOR 'SPARKS CONSTRUC710Tf . T.1'. Dl~sE[2't` .DEVELOPMENT LP 101 WALMN :F3!'t%ME RO N0. , P..O.13OX 1716- 'LA OWNTA : Cly 922$3 t,A.QTJ1NVA. CA 92253 - (619)771-1941 C.HL/I -VX6 (619)771-1941 DESIGNERIENGINEER PESAREK-CR.AMELt , WC. 131P\,TCX'IER I 5-2649 USE OF PERMIT] i'fGi.L A.MIC, D�V.LJT+iC►2,.16,r, e .RANCRO .L:A QUI'NTA • , • • W PALAQ16 PLAN 2 FEE DESCRIPTION' ` FEES CUS'P<,3:M CO;NS'i'ktU S'1ON 3,822 0 L P©ItGEJ/.i='.AT.TO 4 1.80-00 SF C14tAGE/CARPORT 6 ,6.00 SF ,i Fi;STiiilMA TED a:;UST 1.11: CONSTRUCTION 313,191..40 PIP.11NOT FEE 't13MMARV PJ, AN CIE -E- CK FR I {) ).-Q00-A39-3,1 S $1,135.30 CONST.lUt1CT1:0NFEE 101-000-41$-000 y $1,3.95.50 MECfikNICA-L FE 13 $147.00 . &WTIU:CAL FF- 101-000-420.0 0 LUMI NGFEE 101-000419-000'.$4o�,on SIA.'ONG MOTION FM, - REM) 100-000-2.41-000 $31.32 f1TW31NO Fall 101-400-423-000 $20.0 1'f 7RA.S'r1WC`r URF Fm's 225-000-443-342 $6.000.00 P.RFICTSE KAly TOi-000 441. 349 �rS.Qn :..__ ART TN PL1,3 ,1C PLAC88 - REM 701-000-2255-000 $532.95 O 5TAL CONS"1 fIUC°170N AND PLAN CHECK O LESS PRE, -,.PAID FEES $Jk703.16 $0.00 FEe r 2 -D1' 3 199 TOTAL PERMIXTt TES ENOW $9.703.16, RECEIPT DATE BY DAT NALEO L INSPECTOR 14 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 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 K• Final Utility Notice (Perm) COMMENTS: 0 Oj 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 # 549-400-004 No. 14160 Jurisdiction La Quinta Owner Name T.D. Desert Development Permit # No. 79035 Street Via San Clara Log # City La Quinta zip 92253 Study Area 123 Tract # 27952-1 Lot # 4 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 Occupancy for this square footage in this proposed project may now be issued. , Fees Paid By T.D. Desert Developoment Y Telephon4e_ 771-1-941 Name on the check ,;,_ By -Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Payment Received $6.573.84 Check No. 7881 Signature !1 r•1, A x ,a n . ,alt � A .�,vt 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 Ll . a -CITY OF, LA OUINTA LDING & SAFETY DEPARTMENT 777-7012 INSPECTION REQUEST LINE 777-7153 Owner T.D. DESERT DEVELOPMENT Contractor SPARKS CONSTRUCTION Permit Number POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES -79-035 SAN CLARA - JOB ADDRESS SFD LOT 4 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 SIGNED CONCRETE SLAB JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC - ROUGH PLUMBIN ROUGH GAS & AS TE HEATING & VENT - A/C .FIREPLACE ROOF BOND BEAM O.K. TO WRAP 2= AMC _GROUT ❑ 4' ❑ 8' FRAMING -INSULATION � Lr PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR - EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK FINALS ELECTRICAL PLUMINNG FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO \0 m