SFD (9903-035)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 # ��Liic. Class Exp. Date
.t]�l
v6 ate/ 2' ' ? .Signature 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:
(:N-) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the sV�ucture is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
as owner of the property,. am exclusively contracting with licensed
contractors •to construct the project (Sec. 7044, Business & Professionals
Code)., r
O 1 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:
(X) : I 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.
'046-99 Ute IT0007338
(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' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Sec It on`3700 of the Labor
Code, l shall forthwith comply with those provisions.
✓Date O�
Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of'the. Labor Code, interest and attorney's fees. .
. It
IMPORTANT -Application is.hereby made to. the Director of Building and Safety
for. a permit_ subject to the conditions and restrictions set forth on his
application. .
1:.Each person upon whose behalf this application, is,made & each person.at
W request'and for whose benefit work is performed under.or pursuant to
any.•permit issued as a result of this applicaton agrees to, & shall, indemnify
& _hold harmless the City, of La Quinta, its officers, ,agents and employees.
2., Any, permit issued as a result of this application becomes null and void•if
"work is not commenced within 180 days from date of issuance of such
.;perm'it,'or cessation of work for 180,days.will subject permit to cancellation.
I. certify that I have read this application and state that the above information is
correct. I. agree to comply with all City, and. State laws relating to the building
construction, and hereby authorize' representatives of this City to enter upon .
the above mentioned property for inspection purposes
i; ignature (Qwvher/Age_nt)"" �' y "r Date
i
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9983.035 TRACT
3/25/99 28912
JOB SITE -
APN
ADDRESS 49-A,20 IiN SSION D'.7a��'iYFVMf
(49-211.0-Ofh '
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C
T.U. DESERT DE rE'LO.PIMENT
SPAR.0 CONST MUC'T' ON,
P.0, BOX 17.1.6
79-295 PLANCHO LA QUINTA. DR.
LA QUINTA ( C.A 92253
LA QUIW A CA 9.2253
i
t 760771-1.911 CBL # 2196
USE OF PERMIT
v '1uP rAt .
.t
LOT I2. PLAN E1-WD-PERt4 T DOES'NOT 1NCY.irm, BLOCI* wAI.I.,S OI2 '
POOLYLAN CHECi l 3 G k C_ UUCEI� 73'30 rJR i�5(Tl T.CPLR 1SSi� +Nf;E ca'
SAME MAN `CYPE.
CUSTOM CO;46' UCTJ N U35,00 SF
PORCH PAT0 1267.00 SF
GARAGEIOARPQRT 6]4:00 5F
ES.p fllWO.ND COST OF CONSTRUCTION
2201#52AO
I ERN11T FEE SUMMARY
CONS'[7ii:[JCTIONk Er. 101-0130418-000
PL•.kN 0171 CK FEE 1 Q:1»aaa' 1`39-31$ S'21? X10
NfiXZ AN1C€U, ME $105.€10
ELP(1"iR.T Ai.,1 101-000-42tY000 $I62.01
'STRONG MOTION'FES ES - RESID 101-000-211-000 $122.09
GRAEANC FEE 101-000-423-000 $20.00
•i' 17RA,S'TRUCrURF' 225-000-443-3212
ART IN PUBLIC PLACE 3 RESIV 701-000-255-000 $.3172.13
S S. -'?'U A -L CONSTRUCTION AND PLAIN CHECK
LESS .PKE-1"AID i�Lh•S
$f),fiii
TOTAL PERMIT TWEE S DUE. NOW
56,9611.65
�y
RECEIPT
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
- j
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
Exhaust Fans
F.A.U.
'
Framing ka"< Compressor
Insulation
_ j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z C.
Drywall - Int. Lath
--5,
Final
I Z- _ c�
Final —Gc/
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
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 Gp
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 - G�/
Utility Notice (Perm)
COMMENTS:
•