SFD (9903-042)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
I.— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 LU Professionals Code,'and my License is in full force and effect.
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License #' Lic. Class Exp. Date
=) 3�
I-- CY Lo
LL1
6740,74,
�§ighature of- Contractor
.Z I,- � ID - 1,63 I
10 V
Z0:0 r_ �A
0: CID g ,OWNER -BUILDER ECLARATION
Lu, W. I hereby affirm under 'penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:,
U)
,z (- 1,* is owner of the property, or my employees with wages as their sole
compensation, ion, will do the work, and.the structure is not intended or offered for
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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).
(�) ..I am exempt under Section B&P.C. for this reason
LO
.4 IN. . I
'P, , Date Signature of Owner
O -N
WORKER'S COMPENSATION DECLARATION
01 0 , z 1. hereby affirm.under 'penalty of perjury one of the following declarations:
a�'Cc
,7
Lo. 0 (have and will maintain a certificate of consent to self -insure for -workers'
7 7 'is,
X Ld — - compensation, , , provided for by Section 3700 of the Labor Code, for the
_J performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Seciion 3700 of the Labor Code, for the performance of the work for which this
Lo"I -
perrnit is issued.' My workers' compensation insurance carrier & policy no. are:
z carrier Policy No.
00'
-99 IYNIIT000733�
F �Ir; 046
section need not be completed if the permit valuation is for $100.00 or less).
__J
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 thaLif-l-.should become
subject to the workers' compensation prdvi)ions of Section 3700 ohe Labor
Code I shall forthwith comply with those provisions.
Date:;k lkf Applicant
Failure to secure Workers' Comp 4sation'derage is unlawful and
shall'subject an employerto criminal penaltie*-s �an;iiviifines 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
'aitions' forth on his
for -a permit subject to the connd restrictions set fo
, a...
application.7
1.tach'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.
7, .2. Any permit issued as'a result of this application becomes null and void if
1. . work ' not commenced within 180 days from date of issuance of such
or is 0
permit, 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 here by,laothorize representatives of this City to enter upon
the above-mentibiried prZperty nspection
(,for i
r k �/ ,,.. /
,pi�nialure * (Owner/Agent). 'Dat
hl
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9903-042 TRACT
S240,11730 19 28912
JOB SITE
APN
ADDRESS 49,660INUSSION 0R1W,wFsr
fi�9-210-W
OWNER
CONTRACTOR DESIGNER ENGINEER
T.D.DESEUDEVELOPMEW
SPARKS CONSMUCT[ON
P.O. BOX 1716
79-29-5 RANCHO LA. QUINTA DR.
Uk QUINTA CA. 02253
L-A QUfNTA CA 92251
(77 6Q)T71-1941 COL2996
USE OF PERMIT
<Y 1"1k i 1tj V '17 A A If t %f IAX Y ^I t
LOT 10, PL AN E " SITD-RERMIT 1301NOT YNCLUCIP, BLOCK WALLS t.)R
P001 -PLAN CI r. K mr. REDUCED 7:�/. FOR WILT tPL s, t i su ANce OF
SANM PLAN I", F.
MSTON4 CO N.V.I'R.QCTi0'N -2,924,00 SF
PORMPI'V11110 1,235.00 Sr.
aARAWCARPORT 470.00 93F
D
374NIATC COST 0F CONSTRUCT ION
240,11 7.10
PERMIT FEE SUMAIAKV
CONSTRUCT(ON FEE 101,_000_418400
'PLAN UffiCKIFEE 101-000-4394318
Nib"CHANtC AL FBF 101-00042.1-000
aEC-YRICA1. FEE* 101-000-420-000
P1.UNiBtW,+ 101u-000419-000 5175.75
STItOl,iO-k4OTlONF'.a',-'.tU.'S,'ID 101-40-2414)0 $24,01
GRADING ME 101-000•-423-000 320,00
INFILkSTRUCTURE• F -EF. 22_5-W0-443-342 S5,332,31
ART INPM.LIC PLACFS- REStID-MI-000-255-000 5350,29
SUB-TUP-L CON. _91710N AND PLAN CHECK
S7,567-34
_LCESS Pk1-PA10FVES
TOTAL.eERMITFEES DUE NOW
.$7,56734
RECEIPT
DATE
_TE
BY
DATE FINALED
INSPECTOR
L Ll Z/
_ , I ..- - I . 1. - - -
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
'2G-
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
..
(,��
Exhaust Fans
O.K to Wrap
v
F.A.U.
Framing
G
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
7777.Gu I
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
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
6t
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
��
Final
COMMENTS:
Finala
Utility Notice (Gas) I_ D" j
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)