SFD (9903-026)LICENSED CONTRACTOR DECLARATION .
F 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
Signature of Contra ct�� �—
OWNER -BUILDER DECLAF1x1T101V
(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).
(f 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.
II '') I have and will maintain workers' compensation insurance, as required by
S ction. 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.
STS'[ F FUND 0461-91) UNf,`1'0007333
(This,sectlon 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
w6rker5,ec6mpensation laws of California, and agree thaNf I should become
subj ct to the workers' compensation pro/vislonsrof ection13700 of the Labor
2C de 1 shall forthwith comply with those rovisions'.
t% Applicant
Warning: Failure to secure Workers' Co pens + n coverage is unlaw ul and
shall subject an.employer to criminal pena�ltied civil fines up to $10, ,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the, La6or Code, interest and attorney's fees.
y 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.
F _2. Ariy 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 autlio`ize representatives of this City to enter upon
the above mentioned propertyy for inspection purposes.
t�Gz 4�1��
,Signature (Owner/Age'�nt)--7 Date
BUILDING PERMIT PERMIT"
DATE VALUATION LOT "03-026 TRACT
3!25199 $2.20,152.00 3 21-14911
JOB SITE
APN
ADDRESS
49-3401 INUSS i)�i HiQ➢`V� �"�S'ir
e49.2.7 il-di0
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1'-D. DESERT D EVEd,OPMEur
SPARKS CONST'I UCIFION
P.O. BOX 1;'16
79.295 RANCHO .LA. QUthrr 1.O.R.
IIA. QUWrA C;A' 92253 3
LA QLIINTA CA. 922.53
t 1(700)771-1941
Q1L# 2991
e
USE OF PERMIT
LOT 3, .PLAN E1. SaF -'P:9RhfiT DORS NOT YN:;LUT)E BLO `K WAILS OR
POOL.PL AN CW -CK FIFF.REDUCED 7.P/) FOR MULTIPLE IW%1f4XNCE OF
SAk4fEs PLAN T'Y'PE.
CUSTOM( CONST RUQ"-RON 2,635.00 Sl~
PORC"ATt a ?t5 :0ti S3
GA-RACEfCA aPORT 6,14.00 SF
ES'.i'IIMAXE1) COST OF CONSTKILI "TION
2201852MI
PERMIT FEE SIL.NWAR`1i'
C0145T'.RUCT.ION F 101.00114118-000 5.1,063.00
PLAN CliECK FJM 101-000-139-3:15 $217.90
!'eX(MANfCAL FE 101.000- 421.-000 $105.00:E.J,lwC
M1C.KL . 101.000-420-000 $162.01
PLUMINNG.?E, 10.1.-000-49-000
STRONG l O ION• F E - RESfD 101-000-2.41-000
ORADING FEE 101.000-423.000 g'20.00
INFRASTKIJ "URE FU 22$-000-413-342 u."9,27
,ART IN PUBLIC PLACES - IZE.51r. 701.000-255-000 $302.13
slUB-TOTA;1,, CQ1~1STRVC11ON AND PLAN CHECK
I
j �,9ra0.ta?
LESS P12:I. PA1t3:F6,'8S
' $0400
TOTA L PERMIT FEES DUE NOW
%.%0.65
P -A
RECEIPT
DATE
BY •f
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
- DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 6
Underground Ducts
Forms & Footings
Ducts
Slab Grade — C
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 8 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
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
Utility Notice (Perm)
COMMENTS: