SFD (9903-053)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 p. Date
i
� �p3i is
VDat' ,' °` P Signature of Contractors
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).
O I, am exempt under Section B&RC. 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.
This section ne d FUMtNbee completed if the permit valuationisfor $1 0 00 0rtle 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 agre )hat -if lI should become
subject to the workers' compensation provisions of. -Section 31,00 of the Labor
Code; l all-fofthtvith comply with those P vision .
li6ate: t .l Applicants
Warning: Failure to secure Workers' Compegsatf6n coverage is unlawful , nd
shall subject an employer to criminal penalties and civil fines up to $100,0Q0, 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 certify that l 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-mention♦projperty for`inspectlon purposes.
�te
1,Signature (Owner
BUILDING PERMIT PERMITN
DATE VALUATION LOT 99034153 TRACT
3125/99 $240.117,10 10 26913
JOB SITE
APN
ADDRESS
49-8801NIMSIGN liRIi/'E lftST 1
1 "9-210-0135
OWNER
CONTRACTOR / DESIGNER / ENGINEER
T..D..DEESERI' DEVELC IPMEW
SPARKS CONI "f`R.iJC"X'iON
P.O. ROX 17111
79 -?9M ItANCf10 LA QUTI` ..A DR.
LA ( NTS. CA 92253
LA QUINT.A CA. 92253
(761)° x1,1941 CBL# ?9446+
USE OF PERMIT
' A A 1 t1, 413 IL.FG
C• 1A- 7 F'.14
wr 1. M . Ie.• A ♦ • b... elbG • �
LOT 30, PL010-SI'F.'►-PMZ --f T DOU- ' NOT OR.
POOLYL AN• CHECK FTSE 1:1~:fJT,1'f.%'i'1 Mo J' Ofl. ISSUANCE ANCE OF f
SAME PLANTYPE
CUXt10M-L CONS11* UC"1'IOiN 2,924.00 S,i~ -
POR.CT00A1T10 Z5.0 SF
GARAGEJGARPORT 470.00 ,SF
ESTIAIA` ED C'OYF OF MNSTRiXf ,,1`ION
244.1.,1 1.7.14)
li'EItAIfT FXRE SUMMARY
CONSTRUCTION FFb 101-000-41 "00 $1,135,.1111
MAIN CHLKK FEE 101-000-439-318
NW)CHANICAL M 101-000-421-000 $1.31.511
hF,>rC '1'1t1i;AL MW 101.-000:424-000 S t69,2.4
PLfJfvi812e`L:t FEE 101-000-419•-000 $175,75
STRONG• MOTION FEE - RESI,D 101 -000 -241 -OW $24.01
UKADING FEE 101^000-4123-100 620100
Chtk�.ttA; :j'tkUC"1`TJR1i RG 225-000443-34.2 S5.3?21,31
ART IN,PIJB'LIC'P1.ACES - tt>!SW 701-000-251-000 $3_30:39
SUB -TO'T'AL CONMUCT110N AND :Pr t1N C14 -ECC
$7,567.34
LESS "PKE-PsQID FEES
$0.00
TOTAL PERMIT Ff+r•FS DUE NOW
$7.567.31
Al
RECEIPT
DAyTE �� rf �.
BY:-
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
Ducts
Slab Grade
�� Q
Return Air
Steel
Combustion Air
Roof Deck
-
Exhaust Fans
O.K. to Wrap
Framing
�(— _
F.A.U.
Compressor
(�
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
U _
Drywall - Int. Lath
Final
Final 177 3. u/ I`'
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
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
_3 _
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) G�/
COMMENTS: