SFD (9903-049)I' LICENSED CONTRACTOR DECLARATION /
I fiereby 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. Claasss�,�'` Exp. Date
vDate 5 `Signature of Contrac'tor� a L
OWNER -BUILDER DECLARATION
I he 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:
(.) -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.,
(()'. 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. .
4"1'A1'1 FUN
11dti-9q iTtr*'TtIiiJ073;o
(This section need not a completed if the permit valuation is for $100.x0 or less).
( r)• 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 Cal iforDia, and agree that if I should become
31
sbpje,ct to the workers' compensation ptovision/o1 Section 3700 of the Labor
Code, -1 shall ,forthwith comply with those provide
r,Date:' +3'1 Applicant'�°� ---�"r
Warning: Failure to secure Workers' Compensatoin 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
& holdharmless 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
correciA 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 Bove -mentioned property for inspection purposes. �-
4ignature .(Owner/Agent)-- y Date'
t
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT 9"3-049 TRACT
3/25/99. $220,8.2.00 26 259:12.
JOB SITE
APN
ADDRESS
49 -BOO MISSf01ti DRIV C i ST
649-210-05
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T,D. DESERT DEVELOPiLIM-Tl'
SPARKS CONSTIRI;c"T"1ON
P.O. BOX 1716 t
:9-295 RANCHO LA.QUIN7A DR.
LA QUINTA CA 92253
LA QUtNTA CA 92253
(760) rt1-1941 CBL'#t 29,06
USE OF PERMIT }
SLOT 256, PLAN I-Sf -pER�r r DOlw514'(71' iNr':I:,YIL�E.£tI,()t.`iC "sh ALL. OR
1''OC)LYLAld C''I-iI;G`.It Ms it MUCED 736,1o, FOR Ivf XTIPLE ISSUANCTi� OF
CUS' 0M'CQN$'I'.RU4TTQt4 2,635.00 S
PUi1:CkIIPATIO -1 67.00 SF
GARAOi*./CARPOirr 614.Of) '
i:S'I'dti'iA"I`ED COST OF C ONISTKVC"t'IC)1N
2249,an.091
PERMIT Fee, StINI<ii'[Emy
CON&MUC.TION FEE 101.000-41$-000 $11063.00
fsl;AN CHECK M 101-0004139•-31£1 $217.90'
MECHANICAL FEE 103.-%110-421-000 SiOS.f�O
wrRiCAIi. nt 101-000420-000 $162,01
PL.UNIDWO FEE 101 000-419 OO 5179.25
`T.Rallo marim4 FEE - RE&D 1,01-1{}0-241-000 $3L.09
GRADING F1M 101-000423-000 520.00
INFRAMIRUC"1'1JIt1 AVE 225-000-443-342 5I1,Mi.27
r1RT IN PUBI•AC PLACSS - tRESID 70.1•-000-255-000 $302.1.3
SUB-'I'0TA'L CONStR:i; CT10N AND PLA14 CRECK
$i�,�ibtl.ii5
LESS P'I'LE -PAID PEES
TOTAL PERMIT FEES KBIT: NOW
;r
$6,960.65
REG '31P
DATE j
By,
DATE FINALED
INSPECTOR
l�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- O
Underground Ducts
Forms & Footings
- G
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
Exhaust Fans
F.A.U.
-�
Framing
-
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- L
Drywall - int. Lath
( C
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Z -
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
-
7 - e -Appliances
Final
Final .2_3'-(::;b
Utility Notice (Gas) _env
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 cc
Utility Notice (Perm) co
COMMENTS:
Al
as �.�Itl JON TANDY
SEP 13 3:7630 Medjool Ave.
RECD. Palm' Desert, CA 92211
Ofc'772-
• • ' • � AI 47I)Faxe (760)) 772-71937192
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑.REINFORCED MASONRY ❑ FIREPROOFING
C �,
JOB LOCA (�I Qr J L WL_ EJC Wes
✓�� �V'�`. cL� CSV W
REPORT SEOUENCE NO.
TYPE QF STRUCTURE_ - �
PER T 140.0 � _ O �
4l-
p
DAV OF WEEK .
MATERIAL DESCRIPTION
ARCHITECT ,,
INSPECTOR
HRS. CHARGED
-
ENGINEER
ASSISTANTS
HRS. CHARGED
1
INSPECTION GENERAL- _ SUB rS s -
DATE CONTRACTOR P:i�e �S"" CONTRACTOR ., T^'
&-s �� ►�-� �-� s g
r �-j Lw
S� s x
}
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE -INSPECTED TO THE BEST OF MY SJGNATURE OF REG!1§SjtRED INSPE TOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE '
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.` ` OA .E OF REPORT REGISTER NUMBER
r