9601-075 (SFD)• i
;- LICENSED CONTRACTOR DECLARATION +
I herebaffirm that I an, licensed under provisions of Chapter 9 (commencing with
Section-;7UJ0). of IDivision 3 of the Business and Professionals Code; and my
Li6ense is in full force and effect.
License # fi Li6-Cl Ust - Exp. Date -1/31;9 f7/ .
Date if i `Z rrr' [S?ignatureofContractor "( ➢ �, " , ., ^:
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 section need not be completed if the permit valuation is for $100.00 or less).
(') I Ck fo�tfi°attihriApperformance of the work for whichWr1'efmit 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 -,r io 3700 of the L@bor
Code, I shall forthwith comply with thbrolvisions.'
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 iubject 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
C..I'Fti.�'lF.+
& hold harmless the City of Indian ei'lls, 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 pur s.
Signature (Owner/Agent) ' ` Date// / 7' ,� � t�
ALC "BUILDING
PERMIT
PERMIT at
DATE
111.17/9,6
VALUATION
SX86i,.2'�5AC
LOT TRACT
7 2796 1 , r
JOB SITE ADDRESS
APN
:'dig 11144'1.11'A " W f-1 AD
OWNER — — _ -
CONTRACTOR
SPARKS CONSTKUC?InI1
`:',} . DlaSf1PIT'DEVELO.PNIE`.-ar LP
4 101 4LrAi.,seTON 13.11JOCI X3..17 NO
P.O. BOX 016 ��
. LA QU71..11'A CA 92253
LAOpilff A CA 42253
&0IlVr t-1011
DESIGNER/ENGINEER
(619'771-1941
23672B.IRTCf-MR )DR..
USE OF PERMIT
v�: LE FAMILY I)WELLING
1,A.t L 1;URESi', CA '92-63j)D3-!
ItANC1. O LA Wt.td'i'A
PALACIO P1,,tiW 'ii
FEE DESCRIPTION
FEES
CLiST01VI, C01111s '1LUCTION �X465.011 'L1,
,nN
PORC"ATTO 3,45.00 ST
0AF.AGE/C"J10. RT } i 505.00 S.F
ES T IlMATS+:) CO&F OF CON RUCI 9ON '
A661295A
f 'RJO'1W FEE SUMMARY
P%Ate}CW.01CFf~':f: IoI-b t1-taU-.,�41.f3
C0NSTRVC'1'10NL F= 101-0!} 41.8-0110 S1.294.00
�f� CHta1.1(trA1.':�'Ei jQf i/i'71")-��.i-000 �143.St1
1w.— ECtltfCAL FEE 101000-420.000., $213:44
1'7.,1.ti D'I.No rFp. 101-000-4.19-000
STONG W7110N 1'0 - RES1D 100-000.741-000 $29.63
GRADI[NC FEE 101-000-423-000 X20.00
7. FPA8 R JCT.URF. FEE 225-000-413=342 S-6.0000)
PTirZJ,SB k7i.A1d 101-M-441.34.5 2,5.Ot1
ART 1N 1'tUI AC Pl-ACES - RES.W 701-000-255-000 $465.74
M-10161, CUNS71WI T ON AND PLAN CHECK;
$9,462.26
LESS :PRE-PA.i13.VEES0.0a
,.JAN 2 2 1996 TOTAL PE���T Vff, DUE NOW
$9,46216
RECEIPT-
DATE .
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
'OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
,. BUILDING APPROVALS
MECHANICAL APPROVALS
V* 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 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 Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Sm&e Detectors
Temp. Use of Power
Final
utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
DocumentCannot Be Duplicated '" 619-775-3500
CERTIFICATE OF COMPLIANCE "
Date- 1/22/96 • . . L APN# 649-400-007
No. 14058 Jurisdiction La Quinta
Owner Name T.D: Desert Development
Permit #
No. 79065 Street Via San Clara' Log #
City La Qu
irita , Zip 92253 Study area 123
Tract # 27952-1 Lot # 7• Square Footage 3465
'Type of Development' ::Single Family Residence No. of Units 1 -
At the present time., .the °Desert Sands' Unified School .District does not collect fees- on.
garages/carports, covered patios/walkways, residential. additions under 500 sgLare feet, detached
accessory structures or replacement mobilehomes. It has .been determined the above-named owner is
. exempt from paying school fees'at this tune due to, the following reason:
EXEMPTION NOT APPLICABLE
•This.certifiesthat 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.
� W
Development LTD
Y T.D. Desert Develo Telephone n_1941
Fees Paid B
Name on the check
By Dolores A. Ballesteros -{
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $5:959.80
Check No. 7663
Signature pb a a Qnivi 4 '�va� s119.®/I�
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Oriainal- Building Dept./Applicant Copv - Applicant/Rec ft)t Copy - Accounting
a
s _ s CITY OF LA QUINTA
BUIL81 SAFETY DEPARTMENT
777-7012
JAN �1�§§TION 7153 REQUEST LINE
777
Owner TIM W96T97
DEVELOPMENT
Contractor SPARKS CONSTRUCTION
9601-075
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL AP=PLICABLE SPACES
JOB ADDRESS 79-065 VIA SAN CLARA
D:�LAN 1
-Off _7
TYPE OF INSPECTION I DATE I INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING /- i C - L f�/di
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
9
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
ROOF
BOND BEAM
(WO.K. TO WRAP
GROUT 0 4' O 8'
JFRAM I NG
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR -,� c7i• i �---
EXTERIOR LATH -�
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING