SFD (9903-040)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 # Lic. Class Exp. Date
13
late �`� ! Signature of Contractor—
OWNER-BUILDER
ontractor OWNER -BUILDER DECLARATION '10
1 hereby affirm. under penalty of perjury that I am exempt from the Contractor's
License- 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
sale (Sec. 7044, Business & Professionals Code).
tas owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business &'Professionals
Code). SE
O I 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:
",( •) .(;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.
( ) (,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,, ssued. My•workers. compensation, insurance -carrier & policy no. are:
Carrier Policy No.
y '.
.A'f.H �L�i� nth -99 t lNf"I'Oj3t3�:<8
(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,
1' -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.1,khould become
subject to the workers' compensation-provisio�ns•of Section 3700 of the Labor
Code, I shall forthwith comply with,those provisions.
y, ate ;; 0 Applicant
;.
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
audition 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 oni 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
any permit issued as a result of this applicaton agrees to, &:shall, indemnity
&-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 1.80 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 p rp s s
�Slghature(Own r/Agen_t): � v Date
BUILDING PERMIT PERMIT"
DATE VALUATION LOT "03-040 TRACT
3/ZS/9"9 $22%A52.00 17 89112
JOB SITE
APN
ADDRESS 4.9-620 ffI y 'ION DRIVP WE'Siir
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T.D, DESEIRT OUPLOPMENT
SPARKS C_OI�IS T RU'C.TION
P.O, BOX I 7.16
79-295 RAri1C 140 LA Q1 INNTA M
LA QUIN TA CA 92253
LA QUI TTA CA 92253
(760)77'1-1.941 CBU 2996
,
USE OF PERMIT •�
'tmv A ivel v
[OT ;1.7, PLAN':G'l-,ff-D-Pril kTC D r -S NOT INCLLID-E.13 .c.' C UtA!,,tS OP
110.01, PLAN C".1=tECK FEE I;. UCED 7Wn`", MlA `I°fl'f iKISSUANCH OF
SANdE PLAN TYPE. -
_31sT )l C:Qi3SZ'.Ei17(;1'l+ tv ,2,635.40 SF
PORCRIPri`l.'IO 26'7,1111 V
GARAWCAR:t ORT 614AX) BF .
ESTIMATED C08i Orr C0Nsri; RUCT"s1aK
224,85100)
VERMT EEE SUMMAKt
CaI4S"I°R1X''I'3 3_ N FES I O.t-fl00-11£3 060 $,1,.063.00
PLAN GBECK FEE 101-0004394t.8 r217:90
wXC'NNNIC AL E6 , 101-000421»000 9105:00
aRCT RICAL "ME .101.000-420.000 V4"1^•..01
PLUMBING FEE 101-000419-000 $17%25
STR000 t)OTIO'ia "FSE - R1 SW .t01-000.241-000 $111109
GR DING.>i � 101-000423-000 $20.00
A`za-FRA,S`TEt.IJG`I MF, A R. F, 22i-000441-342 $4,ft 27
.ART IN'PUBLWPLAUS -%2 '.521:' 701-000-255.61013 $30`2.13
:,71.5]'•!(YrA i CONIF1.1r.1.IMIN AND :PLAN CHEC3%7.
�C,915f1:�5
LESS . PRE -PAID H1,3
$(); K)
TOTAL -PERMIT FEES DUE E lvOW
$6,960X5
C`
RECEIPT /
DATE
BY/ %
DATE FINALED
INSPECTOR
. , . c,a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
13— `c0 eil Aez-
Drywall - Int. Lath
�.
Final
—Gv
Final
— —
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
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
G -
Neater 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
2. _
Appliances
Final
COMMENTS:
-
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)