SFD (9903-051)LICENSED CONTRACTOR DECLARATION
I hereby affirm Under penalty of perjury that I am licensed under provisions.of
Ch6pter'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
67407
'74M 7�i 99
�]
Date. Signature of C
V ;ontractor
4
OWNER -BUILDER DECLARATION
1.1i.6reby 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
bompensation, Will do the work, and the structure is not intended or offered,for
salq,(S66,7044, Business & Professionals Code).
1,..a§ owner of. the property, am exclusively contracting' with licensed
contractors to `construct the project (Sec. 7044,' Business & Professionals
Code).'
O I 'hm exempt under Section B&P.C. for this reason
pate', Signature,of Owner
COMPENSATION DECLARATION,
I hereby affirm under penalty of perjury.one of the following declarations:
I ha - ve.a.nd wili'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.hay.e.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:
Cartier- Policy NO.
STATE. 11N[) 646-99 IIMT0007338
(This section need not be completed if the permit valuation is for. $100.00 or less)
,
J 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"66rnpensation laws of California,.,and agree that if I I should become
X
suct to the Workers' compensation provisions ofoS19_ctibn 3700 of the Labor
I shall•f ofthwith comply with those gpovisions
vDate: 1Applicant
Wirhing: Failure to secure Workers' Compensationcoverage is unlawful and
shall -subject an employer to criminal penalties and civil fines up to $100 4000in
addition to the cost of compensation, damages as provided for in Section 3�06
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.'
c
1 �'Each person upon whose behalf this application is made'& each, person at
whose 1 .4
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
A hold harmless the City of La Quinta, its officers, agent's 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 offissuance 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
I 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
on
t6e'abo've-mentioned property for inspection 1,P_U?poses
/i�nature (Qwnei,, gent) Date.
BUILDING PERMIT PERMIT #
DATE VALUATION LOT TRACT
3/251" 28913
JOB SITE
ADDRESS
APN
49,840 MIMON, DRiVEArEST
64941.0-005
OWNER
CONTRACTOR DESIGNER ENGINEER
T.D. D&SERT DEVELOP&WNT
SPARKS CONSTRUC1,10N
P 0. BOX 1716
9-295 RANCHO Lk QUINTA LIP,
LA QtW,,A. CA 92,253
LA QUINTA CA 9x253
( -Ofi .1. V
76 77-1941 CBU 2996
USE OF PERMIT
LOT 23, KiXNEW"�'IMMIT DOF-S NOT INO;'TJ�1 J3L(:K,KV-',,VLLS'0-11
POOLIPL.AN CHECK FEE W�)�XW 75-�<,.FORNtM.TfPLE,Y-,.-,U.AN,CE OF
SANr PLAN TYPE -
0=01%4. WKSTRUCTE014 n �.4635.00 SF
PORCHIPA.7.10 3F
GARA.GWCARPORT 04.00 SF
UST VNI A -TED COST OF C ONSTRUCTION
PERNIITFE C SUMMARY
CON-STRUCTION,F0 10,1-000-418-000 S.Ijoo.00
K&N ClIECK ITTE1 101-000-439-318
MF.-r_34.AN1C'V\1, ET.,X
ELECTRICAL Fa. 101-000-420,000 $162.0A
PWIMBING rw 101-�000-419-000
-TVRONG MOTIONFU - MfD 101-M-241-000 $22.09
.GRAU(NO rEE 101-000-423-000 $20-00
"RASTRUCTURSIT-16 225-000-443-3422 $08%27
ARTR4 PUBLIC KACRSAWSW 701-00045:5-MO3 0: L J 3
ZUB-TXAL C0N9rR.V0,T10NAND PLAN 01F.CK
$0,960.65
UiSiS PRE-PAICIFEES
1100-100
TOLD, P CRM rr FM DUE NOW
54,960.165
RECEIPT l
DATE/
B
DATE FINALED
INSPECTOR
I
IV
, /�r
-
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
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
Drywall - Int. Lath
Final
�f
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral f
04
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test �O
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: