SFD (9903-047)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
I /at1� �� Signature of Contcaetor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) . 1,,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 A Professionals
Code).
am 'exempt under Section B&P.C. for this reason
Date .' Signature of Owner
WORKER'S COMPENSATION DECLARATION
I., hereby affirm under penaltyof, perjury one of the following declarations:
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 willmaintain 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.
q i-vfT�ry
(This section need not be completed if the.permit valuation Is for $1t00.O,or• less).
O 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 that if I should become
/4:.
sub0c to the worker's' compensation provisions of Sectio 3700 of the Labor
Code, I((shall forthwith comply with;thoserprovisions.
Applicant
Warning: Failure to secure Workers' Compensation 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.'
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 ceitify 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 aboGe-mentioned property/for inspectionspection purrpo-ses.
lSignatureY (Owner/ gent)
BUILDING PERMIT PERM T#
DATE VALUATION LOT "03447 TRACT
JILV599 S2,40,117,10 74 299,12
JOB SITE -
ADDRESS
APN
49-760 MUSSION DRI.E WUNT
649-210-00.5
OWNER CONTRACTOR/DESIGNER/ENGINEER
T. D.. EES'ERT DEVE, LOPM, 61fl..." SPARKS C-ONSTRUC TfON
P.O. ,SOX 1716 -19.295 RANCHO .LA Q�JTINTA M.
LA C)U NTA C,A- 92,253 11A 1;t1INTA CA 92253
3 (760)771-1941 C38LIi
.2996
USE OF PERMIT
•, u r ,
L,OT 24, P1,AN R2 YFD-PFr1Si`I' D0FS INTO .INCLUDR BL01CK WM. L S 0R
P001.11LAN C-FWC1:.FU REWCED 75%,,F0,R Nf YLTtPIX. iSWANCE OF
AIME P1 .A INI TVWk
CUSTOM (`ONS'l.'RUCIION 2,921.00 SES
PORCWAT:IO 233..00 3F
GARAM6CARPORT 470.M SF
UST VNIafED COST OF C>ON INTR€ACTION
4: t r,1 .:aa►
FEWIT FEE ST)_ tiM KY
CONSTRUCT i FET> 101-000-418-000 $1,1.33.00
PLAT C 4ECK FRE 101--000»439-315 $132." 4
toIiLC1 ANJGAL•.F 101:-000-42i-~JUO $130-50
ELVI-!'RI", F.OR 101-000.420-000 $1409.24
PLUMBING ME 10.1.000.1119;.000 $175.75
V.RONu•ik1CYl1"iGtI YFE-RES113 101-000-241-000 F)E1.t39
GRAIDIi G FU 101-000-123-000 $20,00
INMA;1'i RLICT1W+P,1 ' .FWF 225-000-443-3112
s#P tN,PLMI IC PLACI".% -'. ' 5TP, 701-000-E,55-000 $350.29
SUFI-1.1rfr:!4L, CHECK
$/,56"134
LESS PRE -PAID FEES
$0.00
TOTAL �'F)s MIT .FEF, S DIJT NO%V
S7,%. 7.34
RECEIPT% /j I /
DAT^E f�]� (
BY j
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
ytIZ3 S, —
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof DeckG
I
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
�l� _
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
(J -
Drywall - Int. Lath
G
Final
7
Final
—
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
l
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
COMMENTS:
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)