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SFD (9903-054)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 at�/ Signature of Contractor/ ~~ 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). ( ) 1, 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. (W) 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. STA.`.1'1?`FLYT,�p 046-9 (1NI'1 OOM31K (This section need not lie 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, 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 subject,to the workers' compensation provisions of Section -3700 of the Labor Code I shall forthwith comply with those— p oui ions Date -R Aw A IWI Applicant Warning: Failure to secure Workers '-compensation coverage is unlawful Ind 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. 1 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 theabove-mentioned'pro! eyFj;f. r-iospe� ction purposes. �,� �S'Ighature (Owner/IAger�{)_j�/ `•�� Date's. r = v I BUILDING PERMIT PERMIT# DATE VALUATION LOT "113-054 TRACT 3/25/99 $220,852.0 3.1 28917 JOB SITE APN ADDRESS 49-900 DRIVE, N En 649-21.0-005 OWNER CONTRACTOR / DESIGNER / ENGINEER T.D. DESE11T iDEVELOPIMEN`r SPARKS CONMUCITON P.O. BOX 1716 79-295 kANCHO Lk QCl19rA DR. LA.Q131DITA. CA 91253 Litt wrk CA 92253 ' (76J?7?1-1941 CBL,# 2996 USE OF PERMIT VA h 411 A7 1\FT' 1 1 0,14-` LOT 3 t, PLAN EI-SFD-PERMIT DOES NOT INCLUDE BLOCK WALLS Olt POOL.PLAN CHECK FEERE Ui`M 75% FOR MRI;> IME TSSUANCE Of S 11 _ PLAN TYPF CUSTOM CONSTRUCTION 2,635.008F PORCHMA.TIO 267.00 SF GARAC.MAR-POW.17 05.i.4,00 S:IF ES3TIMML D COSTOF CONSTRUCTION ION 220/852100 1`E"EItMI T 'ITE Sl1.M MARY C014:S'1'RUC'10N.PFW 101000-41"00 $1,0(aw PLAN CHI C.K FEE 1.01-000-439-318 $217.90 ME.t HAINI AL FhT 901. -000 -d2,:1 -t100 $10:.00 ELEC'1lU A1, 1' HE 101,000420-000 S462.01 PI:eUhB1N0'FE 10.1-000-419-0.00 5179.2.5 S'I:Et©No MOT100 FEE. - RES10 t0l-4110-241-000 $22.09 f3MAD1NG FEF, 1,0E-0tf(i-A21-000 $12"Loo I2VPRAS'.C1tUL" UINI FEL-' 225-000-443-342 °$4,889.27 ART IN PUBLIC PLACES - RE, SID 70.1.-000-25.5-000 $302.13 SUB-T(tAt; CONSTR;UC710N AND PLAN CHECK 5u,9ntJ.�� LESS PRE -PA 11) FEES $0.00 TOTAL P'ER.NIff FEES DUE NOW 56,960.65 4f4 f^ RECEIPT DATE BYI DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - Ducts Slab Grade (,fir Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS 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 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 77757 co 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)7-7Z cel AERi COMMENTS: -