9601-086 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Seciion 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect. iy'!,0 f4 B "f/311 �f 1
License f Lic. Class Exp. Date
Date i 'y r' Sig natureofContractor
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 sectIdn-A edmoWe completed if the permit valuatiob is f6ft$fi00.00 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-37�90 of the Labor
Code, I shall forthwith comply with .th se)provisio11 s:
Date: >� �-7 A Apphcent
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 resuklofithi application agrees to, & shall, indemnify
& hold harmlesn 16s the City of IndiBV 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 forAnspection purposes.
,.
Signature (Owner/Agent) � :�- nate
4 -few 75'Ks
ALC«
__.-BUILDING PERMIT
PERM�Tr3I,8
DATE AV /1✓il
VALUATION os JF,i Y °e�
LOT 60
TRACT �Fb.YG't
,a
JOB SITE ADDRESS'�9k-0 10 �f. A VMN lbukkA
APN 649-400->018
OWNER
CONTRACTOR .
r S)?,ARKS CC1NS`I`R;Gt�"'1"" ONS
�y
nV%,t4,o T nl2'Ut7T �1ZJ l..l'�� f i1
A.14:4 .l.. .614
E 1R1 tJfA i t"�=lTT IaA'FIN sL- V _ IN10
1 V'.4 Y.'R°Y.M1:1 MIK 4T 11F.i.4 A/V.1.:: ➢. / • V'•
'P.O. 13CX T f e 6
3 . LA QU NTA. CA 922 a
:LAQVINTA CA 32253
(619')711-134.1 CBIS# 2990
(061.9)771.-1941
DESIGNER//EENGINEER��j
/ wry+ * INC1?7:.7` AMC-Ct1.3'idV+f0.1, IN
2Y,22 OfRTCFIER. DR.
USE OF PERMITAINIQ., h'Y .0 r U
LAM.FOR ST. CA 92630 (7141.8 7-1
RAW.W) LA.t;,)1: 91'A
FALACIO PI..AN 2
FEE DESCRIPTION
FEES
MIWOM CQ N�TRIJ(" 10: 121 3,=00.V
P0RCkf/PA'P.IO„ 1.80100 SI !_
CARACat iCAtZPOitYt' 666.00 S1+' .
t
.4
'i'til'iATE[D COST Q)F CDYSTAUCTION
313,187.40
VE./.RlV!€1(T!"EE t§tPJllhll�',Ei RY
MAN Crt�IC K 036 1,4140-439-3.1.£+
CJNJ1'RLrC1.TONFEE 101-000-�11ft,flQO $.t;,313t3:5t
WKMAMCAL M 141-000-421»0 O $137,00 '
1v.I.>>v'<:TRtCr 'Fh`1~ 1014ft-420-000 $227.09
;P;t tJM91N@ N'.FF F, 1•f11-000-4 i 9-000 S2%.00
10ONG.N10TION, f W- RSID Itltf-000-241-000 331.32
GRADING; M3 01-0/3-423-1100 G$10.00
INFRA.STRUCWRE Fills 225-000-443:- in 501,000:010
�
PRFC- ISE, P.4AN 101,000-443.-:V15
AR7' 1,,14 PUBLIC iP ACWS' - MID 701.000-255.0010 &5 32.r35
SUB -TOTAL CONS`>'R CTION AND P AN C.YECK
LESS PRE. -PAM FEES
'.EES
$9,7113.11(,
$0.00
YID 1 x,11'"& RAM DUE NN€i�'
$%703.16
,JAN22
. X996 . - `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 & 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
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
Final
Utility Notice (Perm)
COMMENTS:
kT7. �N, 7.4aS,;' ,;,a T -aS
Desert Sands Unified School District
Notice: 82-879 Highway 11.1
• •Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500 -
CERTIFICATE OF COMPLIANCE
Date "1/22/96 "N #- 649-400-018
No. 14069 Jurisdiction La Quinta- `
Owner Name'T.D: Desert Development Permit #
r
No: 79070 Street Via San Clara ]Leg .#
City 'La Quinta Zip 92253 Study Area 123
Tract # 27952-1 Lot # 18 Square Footage 3822
Type of Development Single Family Residence Yo. 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 $6,57,3.84 ,
�T
the property listed above and that building permits and/or Certificates of Occupancy for • •J
this square footage in this proposed project may now be issued.
Fees Paid B °- °rte•771-1941�-'
By T.D. Desert Development LTD4 : Telephony,.
25
Name on the check -
By Dolores A: Ballesteros
• Yui �X _ : *§ _ . .
Superintendent' ,tf; ,
Fee collected /exempted by Pauline Pearson . Payment Received $6573.84
Check No. 7663
Signature 1 , Do A„ a �' I Al A ,3 nlYl,
Collector: Attach a copy of county or city plan.check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant 'Covv = Applicant/Receipt Covv Accounting
s { CITY OF LA,QUINTA
%o. BUkDING & SAFETY DEPARTMENT
777-7012 =
'�$QPECTION REQUEST LINE f `
777-7153
Owner. •nP',sESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9601-086
Permit Number -
POST ON JOB IN CONSPICUOUS PLACE'
INSPECTOR MUST_SIGN_ALL.APPL-I CABLE SPACES ,
tt 79-070 VIA•SAN CLARA- "
JOB ADDRESS i - _ '
SFDI LOT IS PLAN.2 ,- .
,NL '
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL'
MAIN GROUND SYSTEM
GROUND PLUMBING Q
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN GNED,
CONCRETE SLAB
JOISTS & GIRDERS -
ELECTRICAL
ELECTRICAL GROUND WORK
DO NOT POUR.CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH.ELECTRIC
ROUGH PLUMBING_,-
ROUGH GAS 'GAS T T G
HEATING & VENT -A/C
FIREPLACE
a
ROOF
BOND BEAM
.--O.K..TO WRAP' - ~
GROUT ❑ 4' ❑ g'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL'INTERIOR 7,
EXTERIOR LATH
POOL PRE PLASTER
n
NCGATEEE && TANK c
_FIN_AL
�ELECTRICAL� - - �
PLUMBING-----_
FINAL GAS TEST •
HEATING - A/C
.HOUSE NUMBERS
JOB CGMjPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1195' r TURN ON UTILITIES OR OCCUPY BUILDING