SFD (9903-039)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that. I arri licensed underprovisions of
Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and
Professionals Code, and my License is in full for6e and effect.
License # Lic. Class EV,. Date
f
Signature of
ate 4e��22 Contract,'
OWNER -BUILDER DEtLARATION
I.hbreby affirm under penalty of perjury that I am exempt from the- Contractor's
U66nse Law for the following reason:
( • ) , ,I, 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
salb,(Sec'. 7044, Business & Professionals Code).
y 1, as owner *of the property, am exclusively contracting with licensed
contractors to construcCthe project (Sec. .7044, Business & Professionals
l'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'
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compensation, as provi ' ded 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
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.
stkrs Fulo 046-9UNIT0007338
1
(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 permii is issued,
I shallAot ' employ any person in any manner so as to be-66—me. subject to the
w6rkers' 'compensation laws of Califo5G, and agreeethat if I should become
§ubjp.6f,to the workers compensation provisions of 'section 3700 of the Labor
Co'de, J shall foahWith comply with thosegovisions—.-)
ate: Applicant
Warning: Failure to secure Workers' Compe' satlon coverage is unlawful and
Shall subject an employer to criminal penalties and civil fines upto$100,00d, in
addition to the cost of compensation, damages as provided for in Section 3706
of 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.
.�11. 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
& hold harmless the City of La Quinta, its officers, agents and, employees.
2. Any permit issued as a result of this application becombs null and void if
work is, not commenced within 180 days from date of issuance of such
;'permit, r . mit, orcessation of work for 180 days will subject permit to cancellation.
I,
certi fy 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 authoMze representatives of this City to enter upon
the ab'ove- mentioned property for iin'spection purposes
..2 Orr
l
4gnature (Pwrier/Age Date
BUILDING PERMIT PERMIT #
DATE VALUATION LOT TRACT
312.5/99 $2.40,117.10 16 29911
JOB SITE
ADDR ESS
APN
. 49-600 Aril: 610IN DRA4, WEST
649-210-005
OWNER
CONTRACTOR / DESIGNER ENGINEER
T.D. DESERT DEVE1C.)PMENT
SPARKS CONSTRUMON
P.O. BOX 17116
'70-295 RANCHO IA QUINTI k OR.
LA QU.WTA CA
'LA Qt 'A CA 92253
192253
(760)77.1-1.041 CBL# 2996
USE OF PERMIT
T.OT 16, P.LkN E-2-MD-PERWIT DOFS'NOT INCLUDE MfXX VkL.S OR
POOL.MAN CIR WiX EFX REDUCED Ma'FOR r4uLT MIX ISSWV4CF. OF
S A IN? M. A 14 TIM L
CIU.Trom coiqmurc-not'l 2,924.003F
PORP-MPATIO 235,00 sp
GARAGEICARPM 470.00 SF
LITMIXTE'D CO91OFF- CONSTRUCTION
24,10,11-7.1411
PERA41T FEE SUMMARY
CONSTRUMONFEE, 101-000-419-000
PL AN CHECK FEE IM -000-439-318
NISCHANICAT,FEE 101-000A21-000 $130.50
FIX.C.1'RICAL FFIE 101-000-420-000 $169.24
101-000-419-000 $1.75.75
STRO-NO MOTION FEE. -'PX-S1D 1131-000-241-000 $24.01
GRAD11140 FEB 101-000423-000 $20-00
WRAMUCTURF F-813 225-000-443-342 95,332.31
AWr rN PUBMC Pl.-A.CYS -.RESIE 701-000-255-00() 1350.29
SUB-Taf-AL COINSTRUMION AND PLAN CHECK
V,50.34
USS PRE -PAID FEES
$0.00
TOTAL FERMIT YEES DUE NOW
$7.,567.34
RECEIPT
IR
DATE
BY
DATE FIN ALED
INSPECTOR
T
_0
-!
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- Q
Underground Ducts
Forms & Footings
QFi
Ducts
Slab Grade'
.
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
Compressor
Insulation
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
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
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Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Q
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) — CQ
COMMENTS: