SFD (9903-031)LICENSED CONTRACTOR DECLARATION
l.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
Riofessionals^ Code, and my License is in full force and effect.
License# Lic. Class Exp. Date
- 17 3. 1 , , "A)
pate' .L/ r < Signature of Contractor—�y
-4
:_?o
W N E R - B U I L D E R.QEC UA/R ATI d�N�
I he . reby affirm under penalty of perjury that I am.exempt ,from the Contractor's
s)
,License Law. for the following reason: '. . � r
.I, asowner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure isnot intended or offered for
§ale•(5ec: 7044, Business & Professi.onals,'Code).
as ' owner of.the property,. am exclusively contracting with licensed
contractors to the onals
C I project .(Sec. 7044, Business & Professi
do
O I. am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I affirm under penalty of perjury one of the following declarations:
.1 have and will maintain a certificate of consent to self -insure for workers'
' . ' I I
�ompensation,as provided for by Section 3700 of the Labor,Code, for the
performance, of the work for which this permit is issued. V
1* 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. STIMIE, rull(r) 046-99 UNIT-001MM-18
(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' compensatio in laws of California, and agreeth-ari$1 should become
subject to the workers' s u' - rkeirs' compensation,orovisions',df Sectio 3700 of the Labor
s * 'e,
Code, I shall forthwith comply with thole provisions.
„Date: 7:X _/, C,' Annii6ant-2/al,
Wir'niin_g:'F'ailure to secure Workers' Compendtion' coverage is Unlawf/11 and
shall'sboject an employer to criminal penalties and civil fines up to $100000, in
additionto 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.
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
A 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.
9ertify, 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 authoriz . 9��repre entatives of this City to enter upon
ih6 above-mentioned property foF"inspection purposes 3 /
VSignature' (Owneir/Aglent) Date
7
PERMIT#
BUILDING PERMIT
"03-031
DATE VALUATION LOT 8 TRACT 78912
JOB SITE 7N
ADDRESS 49-44 0 &G.KRON
649-21"6 15
OWNER
CONTRACTOR DESIGNER / ENGINEER
T) f1j, SKE R1110E Vt. 1.41117kfIr"N".
SPARKS 00XV RUUM0N
P.O. BOX 1716
7 9-295 1W)CHO LA. QUINTA_DR.
LA. QRANT& C'. A. 92 2 N 3
LA. QU1,14TA CA M-5-1
(700)773.-1'941, CIMN 29%
USE OF PERMIT
8 1 &IR )UR FAMILYEDWRLLNG�
BLOCK WALLS 04
P00L.K.W CHECK VIM MiDUCIE30 -7.V/o 1=011 I'VIULTIPLE IS OF
SAME PLAN,
ill'01\111 CORAMIUCT ioN 2,05,00 08F
PORCMPAIM 267.00 66
01WAGW(;ARPOKC 6.14,00 3F
.101,11MA13211) CIOST OF CONTSTRUC7101N.,
-24%052. 0 e,
CONSTRUC710NFU' L01-000 418-000
KKN CHFXK M -F A01 -OW $Z'17,",
MECHANICAL PaLl
EUX'rRICAL MEE 101 -ON -420-000
PL UM 6 rNQ F jig 10140-419-000
RFRONQ`WYQON FW, - _RF'i`0 10 101* -241 -W
CAW11040 FrM* $20.00
AXT Lig 'VIU00(;PLACES - X-ESH, 101, -000-2,53-0ou 3330:.'. 1.3
SUVA-IKYFAL CORFIRUC110N AND PLAN 0-fl5r,K
146,960.65
LESS PRT -PAID FEES
$0.00
'C
'NOTA L P E; R Awlff F 0, 'Y 1)G3 -L' N 0 W
0.65
IDATE
JINSPECTOR
INSPECTION RECORD
OPERATION
DATE.
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—
Underground Ducts
Forms & FootingsDucts
Slab Grade
—
Return Air
Steel
Combustion Air
Roof Deck
_ q
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
2- 2d7,
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2 _ AGG-
Drywall - Int. Lath
Final
Final — 2-
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
p
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) pt I
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 ,— 2
Utility Notice (Perm)
COMMENTS: