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'60. 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
67 074 ki V31199
I
VDa" te;��''� f` L Signature of Contractor a 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.
(� 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.
ix IT-, I,C.r"4r)
(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 -11 -should become
subject to the workers' compensation provisions of Section 3700�of the Labor
�Code, I shall forthwith comply with those provisions.
te:, n / �L Applicant—
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property°for inspection purposes., /
I f
,Signature (Owner/Agent) ! /2Date/")/,-
PERMIT#
BUILDING PERMIT�2{l7
DATE VALUATION S295,409.NO LOT 12 TRACT 1$-2 A Q
J
h
I ". % l i1..0 `, aRva(�
JOB Sift
ADDRESS'
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1113?. DE1110 lt.' DEVELOP it r: r
SPARKS :,'()NST.ItUC."I'1C)�.
Ro. BOX lila
79-295 RANCHO LA QUIN 1'A DR.
LA QU1917t\ CA 92253
LA QUINI'A CA 9225:3
(70771-1941 C1'3r#fi 2!x t
USE OF PERMIT
SINOLE kiWILY DWELLING
SM PLAN .M2, .Laf kZ, �G 2MIT DORS t�IfJ7' INCLUDE, WALL OX
1iC; OL.PLAN C*K) CK l7 a__kkilCtc'931) 75%e.FOR 14f.Ui,'1IRLE I:',3,` DANCE OF
SAM3 PLAN 'i OR
al#�t,%ey:t IIZfJC iL)T++ a,.55v.3() Sid
NORCWPAT IO 44€ljoito Sir
GARACIE/CAh2lx_ttt'I' 636,W t3F
ESTIMATED COST 01! CONSTRUCTION ION
2!)5,4419.;19?
1"�:ltl�I VER SUMMARY
CONS'TRUCFION FEE; 101-000-418-00 $.1._425.50
P1.tlN 4"fif Cott ,F E 1411-1)0')-439-119 SA,T�.82
WAC11#VNICAL I�`liT 101-000.421-%100 $1«1e.r6
J Ii(.v"1'RWAL FEE'. 101.000-120-000 $2'21.18
t�i.U4ABING IrTiF 101�(W-4.19-W) $2:Y.0"
,:'T it]T�tc? M(Y ION FF!1, _ R ?Sits 101-()(1(1..241-'1110 $x.54
ORADIANO:f��:13 10.1.0001 -X12? -0()0 32.0,00
N1FRFl,`,;t'i2t1t;41JR1: EW 225-00-443-312 $6,4100.00
AWF IN PUBLIC PLACE'S - RESI 7011-000-'2^ 5-000 $48f5.52
SIJ6-'r0TAT, CONS7'1�,tlC7 ON AND PIAN t;1iECK
:,,7MY. 6
LESS PRl -PALO I' ES
�0.M
'1!'t)VAL Ii'h;lit�IFf' Fi+,#+;S TjilE NOW
M,711MA; i
RECEIPT
DATE '
BY �>
DATFI ALE
INSPECTOR
CONTROL#
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Y7,
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
s- `?�
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Y Y—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
S—V
Encapsulation
Gas Piping
Gas Test
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
t
Final g
5lfility Notice (Perm)
COMMENTS: