9809-219 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
r- CY LO 199
r
oZ t-- ateYZ" � 6 Signature of Contract r'� r
co O,✓
J U C:) OWNER -BUILDER DEC ARATION
LL W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
F— a License Law for the following reason:
Z_ ( ) 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
O N Date Signature of Owner
rn
dQ WORKER'S COMPENSATION DECLARATION
p 01 1 hereby affirm under penalty of perjury one of the following declarations:
Lo H O () I. have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
C0 Q C) ( ) I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
d rn F— permit is issued. My workers' compensation insurance carrier & policy no. are:
'ZI, Z Carrier Policy No.
r O STJIM. i t'JND 1,171 95
J(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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shal(forthwith comply with those provisions. ,.
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
ICYof 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
�^Vip & 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 repr se entatives of this City to enter upon
the above-mentioned property for inspection�purposesl /
ignature (Owner/Agent) 1t� •jDate's „+
BUILDING PERMIT PERMIT18094119 CONTROL#
DATE VALUATION $1,95.44)9.W0 LOT 24 TRACT 2$,31 0
JOB SITE'
ADDRESS 7941t�A
APN
6$9-210-403
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SPARKS CO.;` STRUCr`t^T;
P.O. BOX, 17 iu
79-2951bkN -110 LA QIJ FA DR.
LA Q1JKI',A CA 92253
LA QUIN.I'A CA, +Y1 2 -i3
(760)771-1941 CBI,#
USE OF PERMIT
SINGLF FAMILY DWELLING
SM, PLAN aim, LCAT 24, PERNU i WIN'NOT INCLUDE $I,0Cfi't' ALL batt
1,100LYLAN CKECK FKE R81)kXH1i 75';®.MC),Ii MUL'I'iPIX ISSUANCL 0
SAME 1PL.AN TY1AF.
CUSTGNI,, CONS IRU "; ON 3, SSC.00 Sr
P RC'I.f/PATTO 44G.W Cil
UARAGEICAltF0R.'r b3G.Uf! SF
ENTI tUTED COST OF C:'G;YSTit1t{:'TION
M449.80
PERtWIfY FEE SUMMARY
CONSTIUA,711CM F86 101-000-418-000
t;A;,iC1�°l'c;K t.FF 101400-439.31.R
Nt,C1LkN1'%,.'AL F Iffio t01-000-4":-000
Et.ECIRICALY.:13 101-f$W42040
I'LM110NO FEE' 101-000-40-000 �xl�.t►ti
`3TRC NUI A-10TION t':YTJv:-'RYf410 101.0«2414)6)1) 'S',9. 4
CZ UI:MM, ME 1101-000-42.1-00
Ii4HUtMR(XwT0RE FFX, 225,"-W-342 3t;,011w) 00
ART JN FILf1`3sAC, PLACFiS •- RH8W 7kj1-000-:,�5-UN1t! Sr1i3R.5
SU"11 AL. COM-31'RIX TION AND KAN CHT -CK
$R,710_56
U.SS
.$0.00
'1UC'AL L'l+:RM117-F1+rEN DI; Ei\i€ W
$8.710.5.6
RECEIPT
DATE
By
D ENALE
INSPECTOR
- N
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
l
Underground Ducts
Forms & Footings
_ _
Ducts
Slab Grade
02 _
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 — G-
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
_
Pool Cover
Sewer Connection
_
—
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
i.
Final(f _ c
Wtility Notice (Perm)
COMMENTS:
I
4" '
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE O ASPHALT
O REINFORCED MASONRY O FIRE PROOFING
O
O OTHER
JOB LO
` 1 � ^ CA t le- ( ^ ` ` ^
f -
/ A Qu t �
REPORT SEQUENCE N0.
TVP OF_SIRUCTURE 1....���
PERMIT NO.
DA E� /
It"
DAY OF WEEK
MATERIAL SCRIPTION
- 3 G -� 3
ARCHITECT
I
�
HRS. CHARGED
F-
ENGINEER
ASSISTANTS
HRS.CHARGED
SUB
DATE INSPECTION Cp TRACTOR ,�; eA e Ki Cenoc-r- CONTRACTOR r - & ��1 W
CA N NST ot-c
f�l�� To �
F�
XTk Tom- p
`S
o
C� ►� T
112.E �le
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SI NATURE OF REGISTERED PECTOR _
rf �'C.A o I6�gi�
DATE OF AlPORT REGISTER NUMBER