SFD (9903-030)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#s" + Lic. Class. Ex . Date
6740 7,31199
�Date a�/� ✓�'ire,
Signature of Contracto. w
OWNER -BUILDER DELLA ATION •..
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: .
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.
O I am exempt under Section j, B&P.C. for this reason
Date , Signature of Owner.
WORKER'S COMPENSATION DECLARATION
1':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: •4,
I have avid will maintain workers' compensation insurance, as required by
Section 3700 of the.Labor Code, for the performance of.the work for which this
peimit:is issued. My workers' compensation insurance'carrier & policy no. are:
Carrier ; Policy No.
STA.TE41IND, tt►aa'
0 or r0= 1^,3.
(T.his,section need not be completed if the permit valuation is or $100..0ess):
( ) ,l certify, that in'the performance of the 'work for which this permit is issued,
I' shall riot employ'any person in any manner so as to become subject to the
workers' compensation laws of California, and agtetr4hat if I should become
subjectlt the workers' compensation pr visions of Sec ion 3700 of the Labor
Code I shall forthwith comply,:with those • rovip sions:
r,DateIf ` ' Applicant t �" _
�.
Warn ngi''F secure Workers 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, dams es 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'arid restrictions set forth_ on. his
application.
]: Each person upon.whose behalf this application is made & each person at
`whoserequest 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 certlfythat I have read this application and state that the above information is
Correct. V agree to, comply with all City, and State laws relating to the building
Construction, and hereby autho_ rize re..presentatives of this City to enter upon
the above=mentioned property�specUon purposes.
1,Sl6nafure (OwneY/AggnDJt)d ,
~7 •./ . r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9903-030 TRACT
3/15/" $240;117.10 7 a891'?
JOB SITE
APN
ADDRESS
49-420MISSION ,DROVE WEST
649-210-00.15 ►
OWNER
CONTRACTOR / DESIGNER / ENGINEER
T•D.,DESERT DEVELOFMFNT
SaARKSCONMUCTION
R0. BOX 1'716 s
79-295 .RA:N�140 LA QUINTA. DR.
L k Q1JT!-JTA• CA. -922.53
LA Q>.T1.1NTA. CA 922:53
0760)7-71-1941 CBLi/ 2996
USE OF PERMIT
r` lid r�;� w c:�:4 tre r14 ..
LOT 7, PLAN 32 -SM -1+€ �viIT MRS tYCi 1' INC'LZTDR:t3LOCK WALLS OR '
POOL ..PI AN CWCK FEE REIDUCED 75°10 FOR, MULTIPLE fSS'UAN(MOF
CUSTOM ;;ONS'I'T�'.Lt"i-f(aN"
Pi$I200ATi0 SF
G:iaRr GOCARPORT ' 470,00 SF
E N't?IMATED M'Wr Or, CON.S',11t .1C030N
240,117.11)
PE.R1.1IT Vrit ST.i10'ISiIItI,WY
CONSTRUCTION FEE l(i.l nGfi-�l.l.f3-Z}(H� 'S 1,1��3,OC3
PLAN C E K FEE 101-000-439-315 X232:=4
-11rC iANICAL FEE 1,01..000-421 -000
BLLCTRUCW::I E 1®.i-�i0r1-��0.000 gt�t9:2a
PL:UkI I11i+3Cs :PFE 101.000-110-000
STRONG MOTION'F,'E - R.:I_.30 101-000-211400 24.01
GRADING FEE $20,00
:t.E+iFR.A,S`t'gtUC'1`CJ12I?,I:,E�C 'i'�w-OQU.�iL13.34'� `�5,�:3'2.3.f
ART INPUBLIC PLACES . I E,= 70.1 -400.255 -WO $:7.5,.29
SC11i 'CO`t: CC�NS'TitU '170) 1 f1N1J� PI.r1N Cl°�.E( 1C.
$1,56734
%,ESS PM-PA11) PPIES
$0,00
®T ,I..�'; !!i➢ f x11'1 'S il1VE t` 0%V
S7,567.34
&\
RE EIP ,_
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
2 _!rR XX
F.A.U.
-
Framing
'f . - I,*—
Compressor
Insulation
_ 02 _
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
1 ! cL I
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
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
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) Z -
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)