9705-155 (AC)U)
H
N_ U)
W
O M
'' C) LO
T
W �
OF) Z
� 0 �
W w O
CL
C0
Z
co
N
ON
Q)
tx U Q
W —
Z
LO -0
XW LL
0 -J
CDQ
O VU
rn
't Z_
Ob 5
C)
J
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
6/4074 -�'� 131N7
/Date< Signature of Coontractor"`T�
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).
() 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.
)6 1 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:
Cartier Policy No.
;3•CA'f`1:4FIND 11711,.`a596
(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 subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisio of Section 3700o''• f the Labor
Code, Lshall forthwith comply With thos proui`si s.
Dats �`S Applicant- •' -4—
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building aneSafety
for a permit subject to the conditions and restrictions set forth on his
application. I
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under'or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless -the City of La Quinta, its officers, agents and.employees.
2. Any.permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance.of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes/
Signature (Owner/Agent) - Dat,4.,-- , 7
BUILDING PERMIT PERMIT// CONTROL#
G
974liS.1 1,;5 5245
`
DATE rG� VALUATIONLOT TRACT
177-335
JOB SITE
ADDRESS t4�TI.ARWCjCDD
APN 769-764-018
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1,,A QUIr)` A O)R.r:f',1. RL)PAIU',,:1`iAS:
SPARK C'C;wni-;.IJi,'.I1.ON.
P.O...9ox 1 116 .
P.O. BOX, 1 116
LA QUI A. CA 9253
LA. QUI NTA CA 92253
(760)771-19411 CUIX, 2996
USE OF PERMIT
!11'))LiN
Vii(! �.6. lt4�t_!1�1 f11JJJl�i'..It7iyi .
lyl,l�.`:Ci9141' C""i�US1�lt�,".i'i.�.T1 ti7f3.(?t3 51
' �i`ie]T.UNILAA.,.i` 0 WNT OF 4„'t'PLiS A R16.Y,s.94.!'4 N1
.�, bn+:/•7•�y�!�
o•�;iij«�'�^al�'$+,�' *��Ji1t`�Ni,1li�1'
PLA.K C;t-tIECIL 1'.# E %11.�UfJ0 i3t3.3J i� "' iia s+)
(:'ONSTRE: I't'"iCIN 1`0i 2111-4;(}ilydl?3-C1tXl p+i:�3 elft
flfla ".1 iAFdxC""ni. ;t+1t1� 101.000-42J -000 � a�,fi�►
INJJMI lN(3 F(sli IM 000_41.9-000 Sv�fi.`d1
S1'OW,f1!IGT E'It �t� P"EF µ W,80 101 -OW -24144.
x(rR-lrPVA 1'. (;'0'Nr°1'1U T[v 1'r4 -N AND.PLAN Ctrll_cK
$844.37
MNA- P.H..P.A11" FEE9
$0.00
T(]►•1'AL PE32_RW t+j'EXS' ADttC"Iv'(iW
$844.37
JUN 05 1997
CITY OF LA QUINTA
RECEIPT
DATE BY / t
D F ALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—Z. 9
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
'1
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Cr
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
— 1
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 }
I.Ality Notice (Perm)