SFD (9903-027)• 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.
F License #, Lic. Class xp. D to
`. P,
Dat�2 �' 15 Si nature 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 her 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.
(Y) I h"Ave'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. compensatiorf insurance' carrier & policy no. are:
Carrier Policy No.
S'l'.F.'C'I fi'i," i7 i)`6fi»5gg i, �•i}U0;'3'
(This section need note completed if the permit valuation Is for $100 or less).
,( ) I certify.that.inthe 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, andel agree at if I should become
subject to the workers' compensation; rovi iZ of Sectlbn 3700 of the Labor
Code •1 'hall fortwith comply with those pfovlslons.
VDate ; 2> I. �� Applicant _
Warning: Failure to secure Workers' Clpensa Ion coverage is unlawful and
sFialI subject an employer to criminal penalties and civil fines up to $100,000; in
addition'to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for- •a. permit subject to the conditions and restrictions set forth on his
application. -
€ 1. Each person upon whose behalf this application is made;& each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of•La Quinta, its officers, agents and employees.
2., Any permit issued as, a result of this application becomes null and void if
work'..is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
1 -certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby-aut orize-rep;e entatives of this City to enter upon
the above-mentioned property for -in ection. • urpors /
t�Signature (Own r/Agent)t -/� a.tel- 2 t fff �
BUILDING PERMIT PERMIT #M
DATE VALUATION LOT TRACT
3/25/.99 5240.117.10 4 2W12
JOB SITE
APN
ADDRESS
49-30 MISSION I5$dlVE WF—ST
849-:21"05
OWNER CONTRACTOR/DESIGNER/ENGINEER
T.D. DESEW.r DEVELOPMENT SPARKS CONSTRUC;TFION
P.O. L='1716 7%)-295 RANC Hcy LA QUINTA DR.
LA QUINTA CA 92255 LA QUINTA CA 9r22j53
q����
CBL# 'N9.7
USE OF PERMIT
t
e. v. r
LOT4, PLAN.in-srD-P3:WT T>mj NOT LA cLUDS-B1.0cK WALLS OR
POOL..:PLAN C14ECK IW RF )tlC,ED i 5°,'o •FC)R tvlV'L'!'.'IPl,'E ,CSSUANG'F OF
RAMP AN TYPE
CUSTOM CONSTRUC'j'' OIN 2,924,00 SF
PORCIUMT10 235.00 SF
GAIRAOFWAR'PU.RT 470,00 ,SF
TV%1J fCID COST OF CONSTRILtC"i 101N
240,11.7.10
PERMIT FEF SGUR'iMAi Y
CONS I'ia=11y14 M 101>000-418.000 SL.133.00
PLAN CBECK FF.:F .101-000-43.9=318 $232.24
NECRANICi•>.~L 1U 101-000421-000 $134.311
FiLeC't'RICAL :FEE 101-000-420-000 $169.Z4
PLU��.'BLNG FEE 101-000-41.9-000 •$175.75
SIMOING MOTION FES - RESID 101-W-241,-000 $24.01
GRAMNO FM 101-000423.00 $20.00
INFRA STRUCT1,1RE FI;Z 225 -(i00 -X143.342 $5,332.31
ART t.P PUBLIC PLACES - RESf1; 701 -(X]10 -?55-000 ' $351129
StJT3=fCY �iC. CC)NS"[Ri►CTtON �1Nfl 1.'1N rF ECI
e$'7,567,34
1 ESS PRE -PAID .FEES
$0.00
(%Vf� TOTAL, WHIT FEES DUE NOW
$7,567.34
RE6F)PT\ /�
DATE
BY
DATE FINALED
INSPECTOR
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
G
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
C, - (
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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
Fndures,
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: