SFD (9907-039)LICENSED CONTRACTOR DECLARATION
}.hereby affirm under penalty of perjury 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 # Lic. Class Exp. Date
6744007lA3� �T3, ___ 7/31/19!
/ate'7/6 ' , !
Signature of Co tra¢to
9
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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:
( ) 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.
Vi 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 i : Policy NO.
(This section need not be completed if the permit valuation is for $100.00 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 U fect to the
workers' compensation laws of California and agree,that if I sho -1d become
subject to)he orkers' compensation provisions of'Section 370 of the Labor
Code, / I s all rl with comply with those p�rQw_sio_DS.
Dat �� . Applicant t
arning: Failure to secure Workers' Compensation coverage is unlawful a d
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, 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 166ph'0�;
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 Ci�is Iw
correct. I agree to comply with all , and�ate laws relating to the building;.,
construction, and hereby authorize representatives of this City to enter, upon
theabove-mentioned property,for inspection pyrposes.
7C/.,. _---- %
VSignature (Owner/Agent) / Date to
PERMIT #
BUILDING PERMIT
"07-0;49
DATE VALUATION2.4Q�.,LOT TRACT
//6
JOB SIT4
ADDRESS 4&673 LA10I4•TANt9.1r1uAY
APN 649-2.."07
OWNER a^
CONTRACTOR / DESIGNER / ENGINEER
C:C:13' St:tt'1 % ;E3 �J[:t.il:lyil9, rf7
SPARKS COMM IJC'Tt'ON
PO BOX 11.146 -
7�L2:95 .RAN'CHO LA QUIWrA 171L
LA. QU NVA j C.A. 92253
Ii: QUIW i'A. CA. 92253
1
y
(760)771.-1.9.1.1 CBL.4 2996
.
USE OF PERMIT
SIN JLE FAA i.fti:11 b1NL;�,UK.:
y ..
8F O , LOT 79 ,iPLA1' M2 - : ERWIfi DOES NOT INe;L'U lal, JCk WALL
OR POOL. 7,V/o KAN 4,"HEC K •tr`EF ;!2}+;if IC11014 :E'C: R NIU1,lTIPL E' ,
1SSU:ANC:`j:i OR SAME PLAN TYPE
CUSTOM CONSTRUCTION 3,5%.00 3F
c: U A O. r �ata.oii S
C,`Ai2.f1C;fiJC:Af2�?+wltt'S" 6:3ti.0@ ,S.I"
"'NT 3:f.1:�ttA•4 L�!/ C() 1. Vi+• r.6 INS R IM cy
'
.n� eA�°i1iY.Q8�'IF
P.1111 INIM FEE sum"Ry
COtV;'t'!TOIC''VION M 101,000-419-M) SIIX25.50.
;NIECI•IAN1CAi FEF 101.1100.421-Otfi.) Y^u1.C1p
ELIX, ICA;: Fa 101-000-4-20-000 $221sJ.8
PLUMING FEE 1011000-1419-000 529 C10
$TROI N% M;O'T:tON .FF—F - RT3,SfD M -000-241-M)
GRADING F& 1-01-000-x;23-ft(1t)
MIRASIT1't.WRWI,Fall 225-00044-342 ",000.00
AR'1' 114 PUBLIC PL.A.0 ES - Ram.k, 7014M-255-000 S�S13,32
StJ?3-r:'M'A.L C,O.NSTRU MMON -AYND PLAN CHECK
$8,7W.56
LESS PR -PATO FEES
MOO
fw �l�l FAJ, PE R1�:R1 .d`.l��Ti,S' 0VJM, 1,` OW9
y �.@ Y }� yip qyy pig y pa ��+ NOW
q
$8,7.10.56
RECEIPT
DATE
BY v (�
DATE FINALED
INSPECTOR
. t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE.
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Q'
Ducts
Slab Grade
..
Return Air
Steel
Combustion Air
Roof Deck
2 66
Exhaust Fans
OX to Wrap
F.A.U.
Compressor
-
Framing G(J
InSClation
Vents
Firealace P.L.
Grills
Firealace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior lath
- !�
Drywall - Int. Lath
-
Final
G, /
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
J
Tz 37 CO -
Appliances
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctu res
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)