SFD (9907-035)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 Date
Vate Signature of Contracto
OWNER -BUILDER DECLARATION
fi
1 hereby affirm under penalty of perjury that I am*.ez6mpt from the Contractor's)
License Law for the following reason:
1, as owner of the property, or my bmployees with wages as their sole
compensation, will do the work, and the,stnJbture is not intended or offered for
sale (Sec. 7044, Business & Professionafs Code).
( ) l,' 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.
1 have and will maintain workers' compensation insurance, as required by
SeKtion 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.
sT.Ar.;
(This section need not be completed if the permit valuation is for $100.00 or'less).
O 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 6f California, and agr e that—f"! ho Id become
subject to the workers' compensation revisions f Section 3700 of the Labor
Code, I sh 11 fOlhiwith comply with'thos rovisi
t( 7
ZD ' e: !:77 Applicant
arning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer t6 -criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building'qnd Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this: application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.,
2. Any permit issued as a result of this application becomes null and Yoi -,i;
work is not commenced Within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation...
I certify that I have read this application and state that the above informatibn>is,4
correct. I agree to comply with all City, and State laws relating to the building"':
u' 11 iid. ng
construction, and -hereby auJho,f'i-ze--re—opirskentati'ves of this City to enter upori"
he above -T, entioned property for inspecti es
OF/ ") / 'M
7 A., 0
\-8ignature�,Qlwn ' gent) Date e 6XI
BUILDING PERMIT PERMIT#
9907-035
DATE VALUATION LOT TRACT
75 411912
JOB SIT9APN
ADDRESS 49-051'5 MONTANA WAY
OWNER CONTRACTOR/DESIGNER/ENGINEER
SPARKS C0NS`R1,b'(._;-r1M,1
POW. 1716 i 19-295 RANCHO LA QVINT.A. DR,
LA 01JIbITA CA, x315:3 1,hQUINTA CA. 92253
1 t (760)771-1941 'COIN 29%
USE OF PERMIT
SINOLF, FANIn.)
-*D -15 P1 K M2 10RAOT D0)a$ 1�10T - 1104CLUDL BLOCK WALL
LOT JV, 4
oit PooL. 75P1,-1i_.AN pKEcK_'rEL, im)wn04 koR. mmtyit-�iB
13SUANCE.09 SAS ALAN TYPE,
CUSTOM CONMR71XV6114 3,556.00 3F
P6,,P,Cur0X,I710* . . 446,106 &F
GiAtWAXARIPOW 636.00 3F
M T "M
. 1%fATJ,?!),CMT Or' CONIz
'TION
WC
C0XNSTRUC"r10NTTX1
101 -000 -418 -WO
PLAN 01ECK M..,
i 0:i, -000_439•-31R
ME CHANICAL 17M,
-000
tLf XITIUCIM, FRU, •
101 -000-420-000
S221,48
PLLM'IN(I FM
101-(W-419-000
10141QQ_241-900
.
17. W_
1.01-000-423-3100
.
$ 24111 1 el 0
N V Riks Irk 0C4,I OW 4 r, M
AR'I' KPUOJAC� PLAC-YiS - HF81t 70140-255.00o
ETAI -ES
LESS PRE D.FE
31$ 01M.NOW
TOTAL MMIT'VE
I - . lull r I
RECEIPT I DATE JDATEFINALED INSPECTOR
"IM9,409.80
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
G</
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
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
Neater 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
COMMENTS:
Final
Utility Notice (Gas) 17J oo--f
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 - Cd
Utility Notice (Perm)