SFD (9903-046)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 Business and
- Professionals Code, and my License is in full force and effect.
License # .- Lic. Class Exp. Date
t ` 4/407 �1f1
,pate)`,� �°" °� Signature of Contractor
OWNER -BUILDER DECLARATION
I 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).
I, 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
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I. hereby.affirm under penalty of perjury one of the following declarations:
(,-) l _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' compensationinsurance carrier & policy no. are:
Carrier' Policy No.
(This section -06 FUND completed if the permit valuation fs o.99 100 00 orrtle s)$
(.) . 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 agree t�i(� I should become
subject+to the workers' compensation%provisions Section 3700. of the Labor
Code, I shall forthwith comply.with those provisions.
Date X Applicant •�� \
Warning: Failure to secure Workers' Compe atiD 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 "arid 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 certifythat 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 or Inspection purpos s.
DIP -
SIg re (Owner/Agent) 1 Dated
V.- l t ,.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT "d)'3" 046. TRACT
3/25199 $224 ,852:110 23 2.89121
JOB SITE
APN
ADDRESS
49-741[1'&,USSIO DRIVEUST
1 649-1I.0-005 .
OWNER
CONTRACTOR / DESIGNER / ENGINEER
T.D. DFSEU E :f E'LOPMT
SPARKS CONS'MUCTION
P.rJ. }it3 171 n
79 �+ :R t1N1.i 10, G.A. QUINTA lrih' .
t
LA QUINTA l C'A 922:.53
LA QUINTA. d :.a 92253
i
(7619)771-1941 C.$:(s '2"6
USE OF PERMIT i
i:i`t. ;'7 at A9 'i'A/ tail •`.
'
LOT 2.3, .Pi.AT4 Et-S•f"D-PERMIT DOF-, -NOJ INCLUDE -A -'LOCK VvAY I.y t: R
POOLPL AN CHECK. FEF .1t6gUCED 757% FOR MU1,TIP.LE ISSUANCE OF
SAME Pi AN TYPE. ^
CC3USTO.VCONST"RUC'f:[ON 2.635.00 St:
PORCH/fP.NT1:0 1267.06 5N
Q-ARAGVCAf• .RT 6.14.00 SF
ESTIMATED CO&F 01r) C'ONSa'RUCTKYN
2201852.00
PERMIT FEE SUMMARY
CONSTRUC7110N IT101-000-418,000
PLAMCMECKf`U 101-000-439-318 17.E
MECHANICAL FEE 101 -OW -421-000 $705.01
UIECTRICA, 4113E 10.1-000.4214= $162.0:1
I'LLA41317NG FM3 101-00041.9-000 $1719.25
STA,0 N0 M0110N FTE- - ASID 161 -MO -.:241-000 $22.09
ORAD.T G:FES 101-110"2"3-000 $20.00
1NFRASTk.C,T(7'd'0R EW 21225-O Q40-342 11,8M9:?7
Ats1' TAl F+T.fkttTr.. PTRACT, - mall: ?01.1900-25,3-0q(i �30,i,3
;K
SUB -:1' rAL CONa'MI:JC ION .AND PU104 CM.CK
$r3,�►G(J,nw
LESS Plt,la-PAID F.E
TO IM,, PERMIT FEES DUE NOW
$6t.96 l.%a
• t/ yli,
/
✓ -_a M,
.
RECEIPT
DATE
BY rt ��,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
- 3
Return Air
Steel
Combustion Air
Roof Deck
V -
Exhaust Fans
O.K to Wrap
F.A.U. I
Framing
-
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2 --4L,:4
Drywall - Int. Lath
L l•
Final - cv
Final -Z 4/
BLOCKWALL APPROVALS
POOLS - SPAS
steel
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
CCJ
Appliances
Final
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) ,
COMMENTS: