COMM (9908-169)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
74 J61120(
D /e. -/ /Ignature of Contractoff�
OWNER -BUILDER -D CCARATION
I hereby affirm under penalty of perjury that I am exempt from the Contracto j'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 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.
s+m ,y n•o - ar. r Hwy+�:
(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,
I shall not employ any person in any manner so as to become_jubject to the
workers', compensation laws of California, and agree,,thdt if I should become
subject to the workers' compensation prOvisions of,Section 3700 of the Labor
C�de, I shall fyfiw'e comply with thoste provisions.
Warning: Failure to secure Workers'.Compensalion coverage-is-untawtI and
shall subject an employer to criminal penalties and civil fines up to $100,0Q0, iri
addition to the cost of compensation, damages as provided for in Sectio 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 authorizeflr_epresentatives of this City to enter upon
the above-mentioned property for inspection purpose .
i4t'u're (Owner/Agent) i Date
PERMIT #
BUILDING PERMIT 4"fl&Ifig
DATE VALUATION isus xo LOT TRACT
JOB Sifd
ADDRESS 49_9%fo mif"i ION ..0101111.1 wtts.i1' APN
OWNER �+ nW lf.*
CONTRACTOR/DESIGNER/ENGINEER
71', 3.a��n'
Ir 0 BOX 1716 79-295 RANCHO LA t'�C. IN-rl�.:i'J3i.
,c.A tit?M-rA CIA 9211253 LA. QtINVA CA 92,253
USE OF PERMIT
COI4?MEX lAL
i;C;sid� �Lr%;.Itfs3,►trs.'s�`£t�€i:'�f � A:::ffv.i't�'�,
:.;.,
t'Ol1.�" UPA'i` O 8800 6F
A Nr Y iA N,�..b. Kd0.D1;1.9 01.x' CO M.5111'.V17f .I��3l .id cia tl 2J* i Y.t1CY
P _tLN € .'F1ir•.CK F t:0 i4,! 14,XO-439-3,E 8 $70.20
CCiNS`1'1�o;if'"t'i�yRl',:�'it t(t6-E}91Q-4tf�3•-Q(1f� �ti'•izt.9u►
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RECEIPT IDATE IBY �� 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
Final
�. �_ �j
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 ^
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)
B'" #City
of La Quinta
Building a Safety Division
P.O. Box 1504
78-495 Calle Tampico
La Quinta, CA 92253
Building Permit Application and Tracking Sheet
Permit #
Project Address: ���� V(ia-m v'j
-v-S 1 IVe e S
Owner's Name: �,'__C
A. P. Number: (OA T — 7-10 —00(0
,,`nn'
Address: 7ri- 2-E)5- totlo vt-uj ( YN,
'
Legal Description: �T�PCC"( Z $� (Z
City.ST. Zip: V��h C I"\- Z Z S 3
Contractor: C�erv1 v��=
lll� 1 t�\
Telephone:
ep
Address:
Project Description:
Cin.ST. Zip:
G�
Telephone:
State Lic. = : (o-74-0-74—.
City Lic. N:
Arch.. Ener.. Designer:
Address:
n /
O l% I • 3
Cite. ST. Zip:
Telephone:
State Lic.
Name of Contact Person: M f-,(ItA— 00b
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone= of Contact Person:
Estimated Value of Project:
APPUCAidI°;DQNOT if1AjTE.B£L01At TM[S 1.1N
#
Submittal
Rtq'd
Recd
T'RACM4G
Plan Sets
>
PJaaChecksttbu�itted
Amount ' "
Structural Csles.
Reviewed, ready for corr"tions -
Plan Check DeposR ..
Truss Caks
Cslkd CaatactPetsen
Plan,Cherk:Balauce
'0 '
Title 24 Cala.
Plans:pieked<up.
construction
B''
Grant lkedPlana
resubmitted
"� auiael'
r
School Fees
Rcv+cFKed;sgdy la.isaa48
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SubcontaMorList
CalkdCongctPersoa
umbiep
/, Q.
Contractor Infra 4:Date
si:permitassae
$iM Y: ;;
p
Cif Business Lic
...
N%'orkers' Comp
Tnirastractare
Planning Approval
_
„ : A:F:P F :.
Pub. Wks. APpr.
H.O.A. Approval
_.:
Fire Mar. Aper.
H. Dept. Approvil
Ag. Approval
Date ofBnalluspectioe ;
Total.PermitFees
:>
Md
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(_VMrVL
City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Golf Course restroom - 49-970 Mission Drive West,.CT
Rancho La Quinia, Tract 28912 1"T1� Gp-� S K-9
Applicant Contact: Adam Booth, Sparks Construction, (760) 341-1515 ..
Applicatio /Circulation Date: 2g
D to
Community Development Department
I )In /f
Christine di Iorio, Pl nnmg Manager Date .
Public Works Department
Steve Speer, Senior Engineer Date
Building and Safety Department
Mark Harold, Building and Safety Department Manager Date
Health Department
Fire Department
Schools Fees Paid
Date
Date
Date
PU4cue-S f
City Of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained..Please return this form to the Building and Safety Department on
after approval. Contact applicant for resolution of conditions preventing or delaying .approval.
Project: Golf Course restroo - 49-970 Mission Drive. West
a rho La umta, Tract 28912
Applicant Contact: Adam Booth, Sparks Construction, (760) 341-1515
Applicati Circulation Date: Q4
` D to
Community Development Department;.
Christine di Iorio, Planning Manager Date
Public Works De ment
VIV
Steve Speer, 9enior Engineer Dae ;.
Building and Safety Department
Mark Harold, Building and Safety Department Manager Date
Health Department
Date
Fire Department
Date
Schools Fees Paid '
Date