SFD (9907-012)LICENSED CONTRACTOR DECLARATION 1
"I hereby affirm under penalty of perjury that I am licensed under provisions of
'Chapter §'(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
o%r-ui��i � �
f� ie - � �" � �" Signature of Contractor`'^-""`" "
V
/ 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 & Professional's Code).
( ) I, as owner of the property, am exclusively, contracting with licensed
contractors to construct the•project (Sec. 7044, Business & Professionals
Code). '
O 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:
O I have and will maintain a.certificate of consent'to self -insure for workers'
compensation, as provided for by Se6tion.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.
S•rA"19.t�clM1 ���-t�c�a�r�d�
(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 agreethat iflr should become
subject to the
J ( workers' compensation'pr?visions of Section 3700 of the Labor
y
Code, I shall ortAith comply with those provisions; a'
.Date: ,Applicant F �'f
Warning Failure to secure Workers' Comp'en4tio�erage is unlawfu end
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 Js 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 Lhave 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 thls••City.to enter upon,
the above-mentioned 1property:for ins/ptioFi purposes : �' �%
ignature (Owner/Agecnt)"^';-'__ "Date• -2.
/. �•"
BUILDING PERMIT PERMIT II
! ?3,I11� /-0,1.2
DATE - VALUATION i'f%91`7.281 LOT TRACT 917 _
A�
JOB SITE
APN
_ d�
.ADDRESS'S il`XIrIVII/ttaP�R �i�#~O'.
F;�b.'3>:GJIi� iIi`J
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SPARKS CONSTRUCTION
PO SOX 1116
79»293rUkNCHQ LA. QUINTA Olt..
LA Qr INTA. CA WIM3
LA QUIN-IA CA, 9'.253
�
%.1.-1941 ICIM 9 2906
USE OF PERMIT f j
SNOLl' FAMILY DWELLING
�3P i tx T S t .1'.C,.A 1.i11 li - Csk'itteii'.i' . S NOT 1`td{CUPa, BL C"KYA L '
ORf(XJi '75%PLANCi"kEXXTEEF-HOUC E'I0MF(.1±?.11,9'.iTI.T'Cfl?LE,
I SSUAN E'OR. SAf 9 PLAN ! VPR-
C11S:T+v3M CO STRUCIMONA `3;Qfi6 Q.0 SF
a�C3it:';f1rx'elT:tCJ 5ff1i.t10 ;iii;
'
t iARAOFIC AliPt312'Jf' 6,93.00.(;F
&'EM_PATIT 9+E SUMMARY
CODNS'I'.F2tMICeNFEE 104-0004.18-000 $1;203,00
f't�A:►vK` CiC.f=_ry 1C?l (4flfi. 3! 3i51 $247.07
iL+FC`C2,iA2t1CrvLFLIs
.e CmicAr me 10i-000420-00
lyl.tJNIB N01";:':.ta 1.01-000-414-000
ea t Rc�r R�1CT'11t%N ► � � r, :e13 101 -WO -241-000
L7RX:t1 '(3 FEU l.f;t fs0t =123 -fit?() $20..Et0
I caT'"MT U01 UR FWE25-000.443-342 59,697.07
1112'1' 1N'.1'U8J;fTC, PLAS 4 S -'KESW 701.0{}0•:_551% t001
SUB-TOrf Al.• CONSIRUC77110'jv: tfl..) Pi1t1N CHECK
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/
RECEIPT
DATE
BY %
DATE FINALED
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
OX to Wrap
— QILF.A.U.
Framing
/- GtS
Compressor —
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
PartV 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
uJ
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: