SFD (9907-024)LICENSED CONTRACTOR DECLARATION
,I 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
0-4707
,Date �7� Signature of Contractor
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.
(Q I have and will maintain workers' compensation insurance, as required by
Sec Ion 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:
Cartier Policy No.
"a RTE I'`�;PS3 046.0W733+11
(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 subject to the
workers' compensation laws of California, and agree that if I should become
subject to the wprkers' compensation provisions -of -Section 3700 of the Labor
Code, I sha I foythwith comply with those revisions.
Date: - , r Applicant r j
/Warning: Failure to secure Worker 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 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 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 r7reseIntatives of this City to enter upon
the above-mention6-d—rp)roperty for inspection purposes.
/ignature (Owner/Agent)
BUILDING PERMIT PERMITN
DATE. / VALUATION $20 ,917.20 20 LOT 64 TRACT M912
JOB SITIY
ADDRESS 49^-365 t�►�O,l�TiviA WAYAPN
649-210-007
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1°D1D.ESF I .T DEVELOPMUff
SPARKS C01'9TRUC110N
PO BOX 1716
779.295 RANCHO LA QU.1N IA DR.
LA QUIKFA CA 92253
LA QWNTA CA 92253
(76(0)771-1.911 M14 2
USE OF PERMIT
SINiGLE FAj1/1IVf DWELLING
I.
SFU - LOT CA PLAN NUR - PERMIT DOES NOT INCLUDEBLOCK IYALL
ORPOOL, OL, 75'1''a PLAN t.'1AhCK MU £tk; XX,' 1QN FCl.EE KyLIT. IU,
1, LIANC71(pit SAME PLAN WPE.,
CU MINI CONSTRUCTION 3,076-00'317
PORCIV'A'110 590.00 Sr
OAKAl1EfCARf<PC*t' 693,00 8N
EIV. 011 AIM D M. IT or CONST INI!, CTIO IN
260.917120
PERMIT P1111E SUMMARY
CONSTRW,1'EC N ITX 1101-000-418--000 $1,2030)
PLAN rm', CK. F F E3 1101140-439-1k9 $7.17.07
,NWE `IIAWICA L F M' 101-000421-000 5I21.00
fvT,Fa.''I iCAf.1ITI I01-000420-000 5:1x5.52
Pf. UN1l,11140 FHE 101-000-414-000 %183.00
81100NCi M0,11014Fi?F.- iti'iCff? 101-004-241-006 52A 09
ORAL)IN 11111' 1.01-000-423.000 $20.00
ifd1 RAt'3`fiK,3t.;'AJKF!. FEE. 225-000-443-342 55,{,iii.(►T
ART itr11?UBLIC T'LfIMS - lilr,�r`W 701.-(it}l?-255.OW '$402.29
S'i.fR-1Y7 '111, C ONS C'1tUG,yTION KNO MAN C EC;K.
R,1 t1K 114
7- . ;1 t LE -ASS .PRETA1D FILMS
$0.00
u �
$8,1(K04
RECEIPT
DATE
BY ' .
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- Z
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
—/ C.0
F.A.U.
Framing
- Cc!
Compressor
Insulation
z"
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- ,• !/�
'Drywall - Int. Lath
'P. -7-4k}
Final
_ ( !moi'
Final — �
BLOCKWALL APPROVALS
Steel
POOLS -SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Final - 6
Utility Notice (Perm) .J.-
COMMENTS: