SFD (9903-056)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
ate1 -?��� Signature of Contractor
OWNER -BUILDER DEC ON
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).
() 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 LaborrCode, 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
WMT FUND completed if the permit valuation s orr $100 0 orale 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 agree that if`kshould become
subject to the workers' compensation provision`s of Section 3700 of the Labor
Code, I shall forthwith comply with those /proOislo s.
(,Date: '+ f C r Applicant '2` 1
Warning: Failure to secure Workers' Compendion coverage is unlawful and
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.
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-authorizerepresentatives of this City to enter upon
the above-mentionec "property for insp ction purposes.
Signature (Owner/Agent Date
BUILDING PERMIT PERMIT#
C
DATE VALUATION LOT 9903-f)'rC�6 TRACT
M15/99 $MjI17410 33 36912
JOB SITE
APN
ADDRESS
9-940 MISSION i)%tNE,
1 649-2111.005
OWNER
CONTRACTOR / DESIGNER / ENGINEER
T.D. DESERT DEVEL.C7PMENT
SPARKS CONSMUC7`tM
P.O..BOX 1716
79-295 P tkNC140 LA QUIIr'TA DR.
LA Qa ]INTA CA 9222.53
LA QUINTA C A. 9?2S3
(760)771-1941 CEL# 2995
f
USE OF PERMIT
°
LOT 33, PLAN U2.S:f`).PFR1VF1 T DOES NO°'i NI CLA DE BLOCK WALLS OR
FVOI :P1 ALN GMC"1:Y13F, T+tli UCED 75"/ FOR NfULTJPLE TSS' ANCE OF �
SAMF PLAN TYYPF3
CUSTOM CONST:H'i3�:'91ON 2,921.130 SF
P0RCRiPXT10 235.110 SF
GARAGwCARPowr 470.008F
&,1UMATED COST OF CONSTRUCTION
240,11 17.10
PE RJAIT FEE SUINAC RY
CON Rtii . i`ION FEE, 101.000-418-000 S I.133.(0
PLAN CREC;1{ FFh 1.01-000-439-315 $23 24
W,CHANICAL Fr -,C 101-000-421-000 S 00.50
C:1..a,1` JCAI. FEE 10,1.000420-000 $169.24
PLIRVIB1NG FEE, 101-000419-000. $175.7:
STItO1`t'G MOTION :FEE ..:1 E --S'10 101-01D0.291-000 �` $24.111
GRADING F'E'E 101-000-423-000 31211.00
INFRAti`1Rtt(. YUKh rht. 225.130()-413-342 $5,332 i1
ART 1N PUBLIC .PLACF-S - R13611". 101-000-255-000 $350.29
Suri-i'OTAC, CONSTILIIC"i`ION JWD PLAN CIM CK
$7,567,3:1
LESS PRI ->-PAID 178ES
$0.011)
-1,0TA'.1, I;'1~:RMIT Fk'ES DUE NOW
37,567.34
r,'
f
RECEIPT ( %
DATE /+j
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
U — 044jwr
Exhaust Fans
O.K to Wrap
_ C c�
F.A.U.
l G�
FramingCompressor
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
Final
t, err I
POOLS - SPAS
BLOCKWALL
APPROVALS
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
,
Appliances
Final
COMMENTS:
Final t -
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) — o-