SFD (9903-052)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 t1 Lic. Class Exp. Date
r
Signature of Contractor -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I ant exempt from the Contractor's
License Law for the following reason:
G )' 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).
O •1 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:
(:) -1 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., r
11T.VrF, FLNI < 04644 U1*il'1007338
(This section need not be completed if the permit valuation Is for $100.00 or less).
( )' I certify that in the performance of the work for which this permit is issued,
!'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' compensatti n^provisions of Sectlon 3700 of the Labor
Code,
1, hall forthwith, comply with those provisions.
101
yDate.'ff Applicants
Warning: Failure to secure Workers' Compensation coverage is unlawful an
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.
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 authorize representatives of this City to enter upon
the above-mentioned property for inspection�urpose .
[/r / �,/
�Slg tune (Owner/Agent),: - Datey
BUILDING PERMIT PERMIT#
DATE VALUATION LOT "0'1'"052 TRACT
3/25/99 $220,852.00 29 •21"1.:2
JOB SITE
APIN
ADDRESS
49-860 NIMSION O#2(VEWES':F
649-210-005
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T.D. DESERT DE"VEWPUE NT
SPARKS CONS'FRUC7'.ION
P.O..BOX 1716
79-295 RANCHO LA QUIN T'A DRi,..
LA QUMTA. CA, 9122553 _
LA QU1NTA CA 92253
(766)771-1941 CBL -9 2995
USE OF PERMIT
l
1
r ti ts' : d ad 'IV 1"YQ 1 ll'hlr. 2
LOT z9, PLAN VrES NOT 13 C3.:tJL E BLOCK WALLS C-R '
'
C�:rEE REDUCED 'GR,1wiUL�r�.p .rssutwcir or�
POOLPL AN CK -C9 `7v. I�
P1. AN TPF.'
CUSTOM CONTPRI!01014 2,635.00 W
Pl7RCklrra NT1:(:1 1267.013 Sr
GARACCUCyARPO.RT 614.00 SF
ENT .��'D 6. Q, Q �F CONIST r{�a.�.I��ia�:O
PERA T HMSUMMA
CO.1 Y.VRUCTION FEE 10:1-000.1.18-000 �,t;ii63.Ui!
PLAN CHECK FtEE 101-000439-318 $217,911
MECHANICAL FEE 1X71-000-421.000 $105,00
ELE(7rW[CAI., 9%. .101-OW420-000 $162.01
PLUMBING INGrER 101-000-4.11MDO $.379,35
S-FRONa Marfoli 1TeE...'R88fD 10:1•-000241-000 $22.09
GMAu.1NGFEE - 101-000423-000 $20.06
W1t,AS1'RUCTURF FIM' 225•-000-443-142 54,889.27
i 3
ART IN P03U1C PLACES -.11M 701-'000-25-1-000 MW
SC SUB-MICAL CONS'rR TUrION ANQ PLAN CRECK
G, ►b9.ii
L.ESS.'PRU,-:P.A ID FEES
$0.00
TOTAL PERINflT IFFYS DUE NOW
$6,960.65
RECEIPT i r -
DATE %/ r
1J1;1 N !Sri
BY/
/iJ!?
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
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
` 4-1 ce
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
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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: