9706-131 (SFD)Cn
H
N_ 1n
W
O Z) M
ir� d U)
W
� w
Z
r i
CD j_ O)
JU-
Ww
H CL
U)
Z
co
L0
N
ON
U °)
o 2 Z
r l— 0
X W W:
m J Q
�U
O
0)H
Itf _Z
c0 5
nd
Q
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
074074
Date
T
?i31i97
Signature of Contractor
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&RC. 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
S ction 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 FUND 13'.1095,
(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
abject to the workers' compensation provisions of Section 3700 of the Labor,
ode, I shall forthwith comply with those provisions.
Applicant f i_ f ':: ..F,-1 r, �JpF: y
Warning: Failure to secure Workers Compensation coverage isfunlawful and
shall subject an employer to crim6al 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 ate
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 enteron
he above-mentioned property for inspection purposes. i
Signature (Owner/Agent) Date ,
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 7*..`# VARK1L1A) WAAk
1i�f- -MSS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
IT
SPARKS CONS"iT.I X110N
Hi Lki ti 171x,
74295 RANCHO LA (COMA DR.
I.A 001ITI'A 1'A 022'3
I.A ("I A ('A 92243
(76017711-1941 ('AL# 29%
USE OF PERMIT
SIF U
:ckD -Lint J� 7 isltk,VA I'1,r�A1 !. 1'I.AN r::EZfiik. F'� ltFsf.aiil::li1., N�` i54••
F(* MCR: rFPLE ISSUE (V `SAME PLAN TYM.
Ci):,Ti)M �X)AIS 1 Kt;J, .'CFCil3 Z 231.00 SF
POKICIi/1'A IO 17000 Sk
OARAiLWA'ARP WT 4%.00 Sk'
FITiMATEDI COST OF CONSTRUMON
1"IM
PERMIT FCIK :#kI1dI tiAlkV
PLAN (IffiCK FEE 1011 -WO -4V.-318 5774.54
C.OWI 'MUIC 1'M fTE 101-000-418.4100 *WV
P► CHAMCAL Fish 101-000-421-000 $98.30
QW. Fh'h 'I01 -000--420-M $161.81
PLIUMIN(3 FEB 101-000-419yM $147.00
,Tr0M MorH) % FIT. - RVIM 101.OW241-000 31$1.515
GRAD11«fG M 101-000-423-000 MOO
1WRAS'rRWI'URE FIE 2250310-44X342 X342 $4.124.71
ART FN PL1N_K:' KA('F.g - RFgIT: 701-000-255.000 1213.9'
M .AN(WN K FTF i0i-t>no 4 -31R-sY�)yF
?�ski, c'(.1N�"i Rt kyf'1c)N ,AND PIAN C11Ec"K,4I10'7
LESS PRC -PAID fTELS-
W- 01 ;.
�13L 141997 TOTA1.1'RltMtT FF.FN4 01IF NOW
Sg,9/M.i4G
t� ( •" "'�r rj� i
•-r
,RECEIPT
DATE
BY ii
DATE NALED
f'
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 Q- G
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath o2 -
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 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) 42 —.