SFD (9903-045)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
G
�ate��I� tom' Signature of Contractor j
OWNER -BUILDER DECLARATION
!.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, 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).
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 mainfaln'a certificate of consent"fo self -insure for workers'
compensation, as provided"for by, Section 370b of},the Labor'Code, for the
performance of the work for which this permit is issued.
()e) 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.
�'U 046 T 'hi iTO 3 3
(This section need n' oe completed if the permit valuation Is for105.0� or less),
(')' I certify that,in the performance of the' work for which this permit is issued,
l '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 should become
subject to the. workers' compensatio�nfp o islons�of Sectio 700 of the Labor
Cfatle; I s all,forfhwith comply with thosrovisions�
vDafe: !
Applicant—k""� % `
Warning: Failure to secure WorkersComp n ation coverage is unlawful and
shall subject an,employerto 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.
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, 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 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-aidthorize representatives of this City to enter upon
the Bove mentionedproperty for Ins ection purposes.
Signature (Own er/Agentp"'` Date''
BUILDINGPERMIT PERMIT#
DATE VALUATION LOT TRACT
TRACT
312SP" $.22U,851.4111 µ2. 28912.
JOB SITE
ADDRESS '
APN
49.120 MISSION DRIVE VirFST
649-:2:111'-005
OWNER CONTRACTOR/DESIGNER/ENGINEER
'',r,D. DESERT DEVFLOPPIENT SPARKS CONSTRUCTION
.P.O. BOA 17.16 79-29.5 .RANCHO LA QT, TNTA DR,,
LA Q1J1NTA, t CA 92253 LA. QUINTA CA 92.253
t (7GOj`r71-I,g1l Cik3.`i 29%
USE OF PERMIT
r-
LOT ?2, PLAICE~ -S •i3•PERUT'DOES NOT MCLUDE BLOCK WA -1,1,.S OR '
1'OOL.PLAN 07ECK FEE RF»DVCED 35n,o FOR NIU1,71PLE ISSUANCE OF
SAN PLAN TYPP. ..
f.
j (..
CUSTOM CONfi.1"4tf ti~TION 2635,00 SE
PORCH'/PATT10 267.0) S1'.
r
GARA.Mi C.A"ORT 614,00 SF
F -S A•1'ATFD CO "p OF C'ON'S-fRUCT[OiN
RZ1�, 5:2�1bi1
CONSTRUCTION FIX 101 -000.4.18 -WO 8.1,063,00
PLAN Ciff-�'&F'FE24, .101000-439-319 $.217.00
NfECHA:NIC.AL
ElXC` RICAL FRE 101-000-420-0041
PL( ,tiblBfNIG FEE 101-000-419-000
STRONG MO'TAON FES - RESW 101-000-2741-000 522.09
Oy,'RAO1NG FEE 101-000.423-000 • $120.00.
INFRASTRUCI`i..COEFFE 22 -5 -OW -4,113•-347 $4,8".v
ART IN PUBLIC PLACES .- Ii:F.sSM 70.1.-000.2.5.5-000 $302.13
SL43-TOTAL CON ; R1.1 -TION AND LAN CRECK.
$6,960.o
LLSS .PR 1: PALT.I fi 61:,5
$0.00
TOTAL PERMIT 3-EES'10(7.P NOW
56,960-63
RECEIPT 1 1
DAA -�
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
C
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
Framing
_
F.A.U.
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 •— U
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 1.
1
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 -GC/
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)
COMMENTS: