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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
�a" !l'e Signature of Contractorst��
uDat.
e
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.
STATE, �s )I�t� 71095
(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 .iVI should become
subject to the workers' compensation' p o isions of Section 3700. of/the Labor
Code, I shall forthwith comply with those provisions- «-
VDate: ,` ! �� ' ' Zrh Applicant-
Warning:
pplicant 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
thabove-mentioned property for inspection purposes.
e.
v5ignature (Owner/Agent) _ •� " -f r �'� Date %" tyl
BUILDING PERMIT PERMIT#tY?�� CONTROL#w
DATE/o/VALUATION S�rli���lE7 20 LOT 25 TRACT 28,ti
-V
JOB SITE4
ADDRESS 79405 CA.UX, URI& t
APN
60-2,10-003
OWNER
CONTRACTOR/DESIGNER/ENGINEER
x.17.1?E
SPARKS CON',"T'P..I. FC TION'
P10. BOX i i 1u
79495 RANC14b LA QL#tNTA OR,
LA. QUINT'A. I CA 92253
LA C,HUWA. CA M53
(760-)7714 941 X341 C:131.4 2996
USE OF PERMIT r
St1dCaL1a; h`.A%#TI,TE".U�i+'I;i.T..Ii�'U
:"iM,'LM41 Mi. LOT 25, f?EWMIT DOE NOT INCLUDE RLOM WALL O
POOL.! ;LiV1 t::IEsEC K FEE Iv` F,1. tlt FD 75% FOR ;v1:1.r@.'1'lPLE, I8SU.A14CE OF
SAME PLAN TYPE. ^
CV131roll CONZITRiJMII014 V76.00 G'
ExGii.Cl�l�'A 1'7n S8t1_Qt► S['
(m.RAGFJcAE2P0jR'1' 693.003F
E9fXlig�`1TED COST OF CO1`-3Sk'1?;i C'TION
260,917514
G.•'4:►'IvS`1TdU�.�l.'IC}M,�[;1s !®1-E10C}-41i7-000 3.1,E;.0fr
PLAN 0-MCK I'IN 101 -OW -439-3)8 $747,07
i11.0 -LA.N'1CAL 17EE 401-000.421000 x124:00
FSC; i'R .(:AL F LI •101.4104.4.20.000 $"205.5;,•.
:PL4N'tZL41.NG EE 101- ?000-419-000 �1N{:t1n
STRONOIMMT SRF",-RESID 101.000-241-000
GRADING EL 1.01-01101423-000 ¢'W.W
1NM- ASTRUC'Ct' RE M3 Z!3-000-443-34.2 $5,697.07
ARTIN' PilBLIC PLA..M • RESTf: 701-000-245-000
1119.1 "I'ALCONSI,T.UC`I'ION AW. ) PLAN CHECK
$8,108.04
USS KX-PAID FEES
.0
EREC�EIP7, ` r
DATE
BYa^' "t.' d
E I AL D
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
-/% GI -
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation�L
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 -
BLOCKWALL APPROVALS
POOLS - SPAS
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
Sewer Connection
` �QL�t�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
FinalG-
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
t
Final 4
ti ity Notice (Perm)
COMMENTS: