SFD (9903-055)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
D['674714
ate'* 4 cs 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:
( ) 1, 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.
SWA'1 !� 04 t:�lrrc►cr0A3zg
(This section need no e 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, end agree that«iW,,Should become
subject to the workers' compensation pro Iv si96 o&Section 3700 of the Labor
Code^I shall forth Ith comply with those provisions.
vDate: `21,� Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful nd
shall subject an employer to criminal penalties and civil fines up to $100,00 , 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 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 ypon
the above-mentioned property)forf,irspectionVposes. ^ I
VSlgnature (Owner/Agent) / 1 Date
l V
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9901055 TRACT
3/25/+99 $22#,852.00 32 2819 12
JOB SITE
APN
ADDRESS
49-920 MiSSTf.N DRIVE WEST 7
649-210-005
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TD. DES1? PI' DLV1 LOP.A tl,:I-.''1.'
SPARKS CO. N.TrRUC 1ION
P.O. BOX 1716
79-295 RANCHO LA. QU1It rA DR.
LA QU1NTA G.A. 92253
LQ,\. QUMTT..A CA 9r.253
(7fl0)/7.1-1941 CBL# 2996
USE OF PERMIT
1
.,, !'1.'I!r '!'? F1'T to �•! /.9 Af 'f I
1v1:)T 3' P! :AN Ll -`ash D-PaM'I° .V()1; 3 N0T livl':LUDE RI,C)CK WAL1..3 OFi
POOI.YLA.N CHFXK FEE RF-DtT(,ED 7T,o"FOR .[ RILTIPLOr .ISSUANCE OF
SA AR l.a F'.
CUSTOIN4 CON 1T[RU " 1C K 2 05.06 SF'
PORClYPA^IIO 267.00 SF
GARAGEICA M)ORT 614.00 SF
1<<;.�,s'nuui) can OF cwf saRvc1'it' N
220,852.1W
'i"EttiRW i't`EF, SUMMARY
C0X3T.1WC1rI0NFX 101-000-41,13.000 $1,063.00
PLAN C--IfEiC '1 E , 01-000.439-315 $217,.90
,N1E,CH,AX1CA1. FER 101-000-42.1.000 $103.00
E PG" I RIC.AG [+'lis 101-000420.000 �Ib2A1.
PLUMBINCI:F-EE 101 -000 -419 -WO
:31'WoNe) i+10TION FM - RESf 3 101-000-241-000 1$221.09
()RADI'NO't't%F 101-1:100-473-000 &.V.00
INF ANTRUCTir4X-'F".1714 225-000-143-3:32 811,?19.27
.ART IN.Pt11 LIC PLACES • RES1T 701-000-255-000 s3o.13
SUB-TUFAL ;;;ONS'1'1tiJMIGN AND :i'1..AN CHECK
.LESS M PATE) FEES
$0.00
TOTAL .P.ERI1' IT VMS DUE NOW
56,960.65
r
REQ EIP T, A/
DAT ,s ,� - ��
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
Return Air
Steel
Combustion Air
Roof Deck
026, Azw
Exhaust Fans
O.K. to Wrap
F.A.U.
-
TU -7r/--
Framing
Z_0:yq q lnk
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
Final172-
742 q,51
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
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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