SFD (9903-038)LICENSED CONTRACTOR DECLARATION
Lherelby 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 # Lic. Class Exp. Date
574074
/at'�e/�S'),Signature of Contractor!
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
icense Law for the folldwing reason:
1, as owner of the property, or my employees with wages as their sole'
compensation, will do the w ' ork, 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 lice nsed
contractors to construct the project (Sec. 7044, Business & Professionals
Podia)'
I am exempt under Section B&P.C. for this reason
Date 'Signature of Owner
WORKER'S COMPENSATION DECLARATION
I here ' by affirm undbir.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.
I have,and will maintain workers' compensation insurance, as required by
.'86atidn 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.
TA.C.E
0
UND 46-90 UNJTtW7.1,4,�
(This section' need:
not be completed if the permit valuation is for or less).
(J'.1 certify that in the performance of the work for which this permit is issued,
l"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
subjeict to the 'workers' compensation pr69-0—ons of Section,3700 o the Labor
Co e, I shall forthwith comply with those prov ns--
Applicant ?<'
Wairning: Failure to secure Workers' CompensatLo.neoverage is unlavftl�ancl_.,
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 they Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby rnLe 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 benefi-t work is performed under or pursuant to
-,'Any permit issued, as -a result of thii 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
s• 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.
1'6ertify 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 u pon
. I.... I __-1 t
the, above-meintibiibd propeq, for inspection purposes. %
Signature (Owner/Agent) .— Date 6
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 99.03-038 TRACT
JOB SITE
APN
ADDRESS 49,580MISSIONDRIVEMST
649-210-005
OWNER CONTRACTOR/DESIGNER/ENGINEER
TD. DESERT DEVELOPMENT SPARKS CONSTRU-710N
P.0:13U: 1716 7±4-295RANCHOLA. OX.H-CADR.
LA QUINTA CA 92.2.53 LA QUINTA CA 92253
(160)7714941 CB11JU 29945.
USE OF PERMIT
J!'A Xfl V flOtir I tj4r
.WT 13, PL Aii M. -Sr, D -PEs. AFI t DOES 901 INC LUME BLOCK WA1A_13 CYK-
P0011-PLAN CHECK. FEE REDUCED 7Y% FOR _Mtf1lT.1PLC fSSUANCS OF
AAV, PI -AN T VPF.
CLTISITON't COMMUCrICIN 14634.00 SF
PORMPATIQ_
QARA0VCAHPQRJ'
ESTIMATED COST OF CONSTRU(J ION'
PERPM FEE S "JINJARY
OGNIMPIUCTICYN, Fl 1; 101-000-418-000
PLAN CHE CX Fri -T, 101-OW4430-318 .$217.90
NIF,C,HMICAL FES 101-000-4,21,000
101-006.420-000
PLMfB]NC- VIEE. 1101-00D.419-000 S179.25
STRONG MOT 1044 FEE -RE-50 101-000 a41-000
GRADING -FEE 101.004,23 -OW
1NPRASTP,UCTW,F FEIE `4225-000-443-342 so69-v
ART,IN.PU,9IJC PLACCIS - , Rflsff'o 701. -ON -255-000 s341",13
SUB-TUf-AL CONErfRUC-110N -AM)PLAN GRECK,
$6,-96N35
• LESS P11r13-PAJ D PUES
TOTAL PERIV11T FEES DUE NOW
%'9o.6s
RECEIPT
DATEBY'
DATE FINALED
INSPECTOR
� ; /7 '%' v, /
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs — l
Underground Ducts
Forms & Footings — L
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck $
Exhaust Fans
O.K to Wrap -
Framing w- q
F.A.U.
Compressor
6�
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
P
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final �U
BLOCKWALL APPROVALS
Final
Steel
2 -� •-�
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
Utility Notice (Gas) Ll _ C6 - GL/
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final -
Utility Notice (Perm) l.,
COMMENTS: