9903-043 (SFD)i 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 -,D to
B
tiDate ✓ 'f Signature of Contractor
OWNER -BUILDER DECLARAT40N'
I: hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
as owner of the property, or my employees, with wages as their sole
compensation, • wil I -do the work, 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 licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code);.
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:
(,) <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.
(y!) 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.
.nme•rr: r:t»,ryry r.f� et•»sra:r,y.nfl'!re.::
(This section need not be completed if the permit valuation is for.$100.00 or less)..
(:) 1 certify that in the performance of the work for which this permit is issued;
I•s.fiall 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
Subject to the workers' compensation -provisions of,Sectio -3.700 of� th�Labor
Cofde I shall forthwith comply with"tthose�provisions.
✓Date�Vi '�� Applicant
Warning:. Failure to secure Workers' CompoAation 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, interestand 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.,
j'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 becomes null and void if
,'work is not commenced within 180 days from date of issuance of such
F:. permit, or cessation of work for 180 days will subject permit to cancellation.
l.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 propee ty for inspection purposes.
�.. .f 1 � ... f�.5: "�•�:.
VSignature (Owner/Agent)-"�,Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9903-1133 TRACT
3/:2 i�39 22it,315?,.lif1 10 2802
JOB SITE
ADDRESS
49-650AUS-SHON i�R3'�v:r '1�'F,5iT
(49-:2.1f3-005
OWNER
CONTRACTOR / DESIGNER / ENGINEER
T.D. DESERT DL'VtLOPMENT
SPARKS CONSTRUCnON
P.O. BOX 1716
79-29:5 RANCHO LA CQU1.N7.A llR.
LA. QLWfA CA 922.33
LA. QU1NTA CA 922,53
I
(�s0)77'1-l.d 1 CBLY ' 2996
USE OF PERMIT ,{
ttr w, -V a,y Lr<r;r r ;
Lt7T 20, PLAN E1�S1 D -P , e1 DOES NO`i.' INCLUDE }3l om, �,�iALL-3 OR.
P001,,PLAN CHECK F1 Fs REDUCED 75% FOR. NiT,fLTIPLE ISSUANCE OF
61t1I�fE PLAN TYPE.
f
CI7S JrOM CGO.N.13MUC:TION 4615,00 SF
;
PORCF1ePAI 10 2�7.00 S1:
G+r PLAGEXARPORT 6,14:00 sr .,' .
,�'♦ri ►'r+rsC(+.^f• ^yj A{i !�r fir ° :►lr'9'A01'�4
a1:wP i NVA.t1 1.t�11I.16�✓1,. 1..�4YA�
�,�e� asci► cii
Gfti�q �.G.1.eV
PERMI a FER SUMMARY
CONST.RUCTWN,F`R, 10.1..;000-418-000 I,Oti3Al)
PLA14 C`IMCK FEE 101-OW439.318 31.8 V17.90
l iECHMICAL FR '101-000=121-000 S105.0
ELECMC"AL BEY, 101-i10", 20 -WO �754.U1
PLUN11BING .FET -H 101w000-419-000
STR04 O MO`fTlfat`b "�� - €3E3.iC1 101' 1►0+?,2�11-0t)0 �22.t39
GRA ITNO'F1 F [01�-0(it)-42U00 $26.00
1i FILA.S`IRUC:t`URE'FEE 225-000-443-342 S4,389,27
ART IN PUi3iAC; PLACES -:R1 S11✓ 701-000-255-00(1 $,3[r.13
SUB -'.(D AL CONS-MUC11ON AND PLAN C1-iW.h'
�►,)aO.Gt�
LESS PRF -PAID TEES
$0.00
` OTa 1,1Q1v3ii1UT FEES DUE NOW
$6,960.65
ij
Nj)�i^°
RECEIPT /
DATE 5+, c!�
BY 1
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- OYETUnderground
Ducts
Forms & Footings
Ducts
Slab Grade-�
Return Air
Steel
1Combustion
Air
Roof DeckExhaust
Fans
0. K. to Wrap
Framing
_ _
-
F.A.U.
Compressor
_
Insulation
- r / • -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
6-3
Final
Final
BLOCKWALL APPROVALS
Steel
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
CC1
Appliances
Final
Final 1 (�
Utility Notice (Gas) <510
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)
COMMENTS: