SFD (9903-041)LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed ,under provisions -of
Chapter 9 (commencing with Section 7000) of Division 3 of the Busiriess and
Professionals Code, and my License is in full force and effect.
License # Lic. Class . Exp: Date' '
s 1.i
vDate� Signature of Cont ac' tori
r ..
OWNER -BUILDER DECLARATION
I hereby affirm undee penalty of perjury that I am exempt from the Contractor's
License Law for.the follow_ ing reason:
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).
( ')' .I,.as owner of the property, am exclusively. contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).-
( ) I am'ezempt'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.
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.
STATE
tz°a fi"ff'tTix�(�g
(This section need not be completed if the permit valuation Is for 100. 0 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 agr e,*at if I should become
`subject to the workers' compensation provisions of Sectib of the Labor
Code,_I shall forthwith comply with thos p..royis ons.
v6ate:r' - Applicant j.=
Warning. Failure to secure Workers' Co4pensation 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..
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.
A. 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 appiicaton 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
permit, or cessation,of work for 180 days will subject permit to cancellation.
I certify that'I have lead 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 purpos:
.I'
( 'moi � � �
vSignature (Owner/Agents" v Date_
BUILDING PERMIT PERMIT#
DATEVALUATION LOT 9%13-041 TRACT
. Wiz: �azo,s;;sz.00 l� 2S�1ry
JOB SITE
7ADDRESS
OWNER
CONTRACTOR /DESIGNER/ ENGINEER
SPARKS C0ZgS"rR1.C'f10.N
:1716
79,29: R ANC140 LA Q l'VAII'A..DR.. '
'L.A QU%N' A CA 92253
LA QUTNTA Cry 1225.3
(7at0)17.1�l9�41 CBL,: 25 5
USE OF PERMIT
r. .
LOT 13,1PLAN E1,81711 -1 -PERM -IT DOCES NOT IINCLTIE ►A. LOC'f � WALLS OR
OOT. PLAN CT tl; K, F91 REDUCED 15O!a FOR kftff 11PLE, 15SUANCX OF `
q A10P 1Y1 AN TMP
l'3L'1STOBdCOINS'.,lRU,.,TJO:N 2,635,00 .ii
PORCIDPXP KI '26., tal
UARAGliii,AR11ORT b,1r1.lffJ 'Sl'
F..S7'if -1.1 'i3 C -CWT OF �:i�iVS°!`At�:i(;TICI;�i
22•#1,14�� iltf
PERMIT FEE Sill4i.li1l kRY
CON37i10-11CTl.ON F EE 10.1-Oip-41.S li(JO $1.,063.00
11
PLAN CRECK rte•
WC.HA.NICA FF.E 101-000.12.1-000 $105.00
fi LF,C fK[O,P►L ,F9t1 101-000-420-000 $162.01
PLUMBING FEE 10 1-000419a)a . $179,15
ST.Rt3NO MOTION FEE - R SW 101-000-241-0100 122,09
GRAD= ';"i E 101-000-4-ZI-000
��ckT7wc�.FEt✓
ART IN PUBLIC PLAM - RESM 701-0&0.255-000 $302.13
SU18-Ta'I'A < CONSTRUCTION AND [ALAN C111:ECK
$6,960.65
LESS PRE-PAIDF,1sR$
$0.00
TiJ TAi, PERMIT 1^1rl S'DUE NOW
`F66,960.65
/j
RECE i "
DA E
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- p
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
– j !ice
Exhaust Fans
11--A—_
O.K. to Wrap
Framing
p
F.A.U.
Compressor
C _
Insulation
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_ O C7
Drywall - Int. Lath
Final
– �/
Final - —�/
BLOCKWALL APPROVALS
Steel
POOLS -SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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�j-
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) (� O
COMMENTS: