SFD (9903-036)LICENSED�CONTRACTOR DECLARATION
perjuryi' '� I ' ' licensed: under provisions of
1 hereby,affirm under penalty of that am
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
674074 13 7!;3:199
Date—, -7 L Signature of Contrkto:
57�/ / t
OWNER -BUILDER DECLARATION
I hereby,affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
1, 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).
(,. ) 1, 'as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
l.am exempt under Section B&P.C. for this reason
Date —Signature -of Owner
WORKER'S COMPENSATION DECLARATION
I hpreby affirm under penalty of perjury one of the following declarations:
);II
. ( have and will maintain a certificate of consent to self -insure. for, workers'
compen , sation, as provided'for by Section 3700 of the Labor Code, for. the
performance of the woirk'for which this permit is issued.
I 'have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work" or which this
permit is issued. My Workers' compensation insurance Carrier & policy no. are:
Carrier Policy No.
31'ATS 1, UM
(This section heed not be completed if the permit valuation Iso $100.00 or legg).
(+ I Certify that in the performance of the work for which this permit is issued,
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-Section,3700 of the Labor
C�e, I shall forthwith comply with tho'se-proVigi,ons.
ate--\ 12 'S 14� 'S Applicant f, (A i
7
Warning: Failure to secure WorkerCompensation .cove rage 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.
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
an * y permit issued as a'result of this applicaton agrees to, & shall, indemnify
&.hold. harmless the City of La Quinta, its officers, agents and employees.
a .
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
pd,rmit, 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 inspectio—nNrposes.
X�:
,Pigna.iure (Owner/Agent)--v4� Dal:67u/�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9*)3'f)36 TRACT
? .
3/2,5199 5240,117.10 13 18912
JOB SITE I
APN
ADDRESS 49-540 NJUSSION DRIVE WEST
649-24(1-00
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T.D. DESERT DEVELOPMENrr
SPARKS CONWSTRUCIJON
P-0. 80X 1746
79-29-3 RANCHO L,A QUINT A. DR,
Lk QUINTA6, CA. 92253
LA QU NITA CA. 922.53
(760)771-1941 C 2490
.BLY
USE OF PERMIT
LOT 13,m.,1N F2,.,,rD-REWV N-CLUDE BLOCK WALLS OR
PO OL. PL AN GHECK R*,jE.REJ?PC 13D 7 _-Pl. FOR N9JLT tPLE ISSUANCE OF
f, AryfF PLAN TYPE.
C'USTONI CONSTRUCTION 2,92-11.100 SF
PORC-PPATIO 235.00 SF
GARAOFYCARPORX 41170.00 SF
ESTIMATE 1) WST OF CONSTRUCTION
240,117.10
PERNUTFEE SUMMARY
c(YNs1.,Rucr1ONFSE 101-000418-000 51.133.00
PLAi4 CMCK FEE 101.000439-318 $232.�0
DAECHANXAL FFE -OUO-421-000 S1130.50
FLC.a11UCXL FE Ell 101-000410-000 SA69.24
Pd (RUBING F137 101400419-000 $175,75
STRONQ MOTIONRIm -RE&D 101-000-241-00,0 $24.01
GRADING FFE 101-000-423-000 $20.00
NFRASTRUCILFRr• PhJ3 225-110(3-•443-342 $5-33231
ART IN PMAC PL.A4E1,3 - RFSIr, 701-000-255-000 $350.29
SUB-T(YrAL CONSTRUCTION AND PLAN CHECK
P,567,34
OU
TOTAL PERMIT FEES DUE NOON"
$7,567.34
ell
RECEIPT
DATE
DATE FINALED
JINSPECTOR
_"t .4
2
iB
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
L
Ducts
Slab Grade
G
Return Air
Steel
Combustion Air
Root Deck
Exhaust Fans
O.K to Wrap
..
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Griffis
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
of
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
r2k
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) /` C0 (!f—
COMMENTS: