9711-111 (SFD)U)
N W
O 0
^W�-
o Z
Zo0o
H
J
r`
�a
fA
Z
M
U)
N
ON
U °)
d Q
Z
�aCr
0
W
X W —
0JQ
mU
O<
d 2 H
t Z_
c6 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 ExpD ate
�i11. L)-? �3 .....�i� 11.1 •�+(i
Date 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&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.
"l'A" i.I r'Ut*%V 137109.597
(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 provision`s of Section $700 of the Labor
Code, .I h shall.forthwi comply with those, provisions.
Date:1 / 21' I Applicant ' i,4_
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of -this City to enter upon
the above-mentioned property for inspecti�rposesr
C
Signature (Owner/Agent) � `- Date f I
BUILDINGPERMIT PERMIT# CONTROLk
II 971i-11,1 �
4 LOT �X TRACT
DATE �� / VALUATION 3 8 9
3�fr�17
ADDRESS %if iL}} 4 lift;.s..tj 4�et��
APN 6".420MI4
OWNER
CONTRACTOR/DESIGNER/ENGINEER
rI % 1,41 4nr
i'.u. i3OX 1 "1 ici
;?,291 RANC'# 0 Ut OUKVi a_)R.
I,A QI)1N'1'A CA 92253
� GA QUIN'1•A CA 142253 � F'
771-1 941 41 011114 1'1',K
USE OF PERMIT
LOT tis, T E RRAZA ! LAti i - :'1e04T CYDES NOT ihiCLUI-I- -11 f3i.n /AiID
QR KJ01.. iUPP (. KEA.HT OFS'pl3,!rti IIFR C%Jmm. DEV. I)1:irl'.; I11.11IN r-1
997
11ftcrf/,7 r1e� 17tk.c161 LA
OUNTAI
t: aARACIFJC.AK1xXI' 486 0 31•
1`
�i.;STIIS3:c�'I`E'D COST Lite COQ+ N'3'1;2�'�"Y10N
18515481.50
F'FR1%HT 1'FFl S0M1%fARV
PLAN QIht. K ICER }(}t 11)13(►-��El �t113 Sl+�3.F►�!
0-►NS•TRtu;TIpN fq.:r 101-W-1I$-tlpf) x410 Cia
t; O11ANICAL FEE 1131-000-1211-000 VP31 `•t)
F.IA-CTRiCAf. VMS loi•{3t►c( 20-wco $11;7,111
PLUMR1NO flit: 101-WO-419-(1tM.? SI42,(�f
0o3'R0N0 kfC►T10N R-: - ft;;S1l) 1111114M -'141 -OW 312
L',`I2AJI)ING 17131's 101 -001)•423 -OW S:1►.�f)
INFRASIRUC�IRC Hir, 2254W-44-342 S4.I:M.71
ART IN Pt.IBLI[C PLACES - R1«S11; 701-0010-7.55-Q00 S:S i.yi
ARY IN Sit rilf.lC P1,AC II Y - P13-411], 7011-00n-'15 -
;`UP-TMY A 1. C'ONt yR1_J "r10N AND PLAN C14F-rK
LE"s ."RE -PAID FF31::
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
C
Underground Ducts
Forms & Footings
—604 C
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
—1 L
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
—
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
I I
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:
12 w 3U_ �''�`q'�-R— 4e -H-- Sduk
-
Final 7A=12_
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)
06/04/1998 05:43
619-771-1841 SPARKS CONSTRUCTION
eA.^JINTA
n •�ATY OF LA QUINTA
NO & SAFETY DEPARTMENT
m-7012
09MECTION REQUEST LINE
m-rTs�
Owrwr T.D. DESERT DEVELOPMENT
Co„t„ctor SPARKS CONSTRUCTION
Pwn* Number 9711-111
POST ON JOB IN C NSPICU US PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
J08 ADDRESS 79-720 CABRILLO WAY
LOT 28, TEARAZA PLAN 1
SFD - PERMIT DOES NOT INCLUDE BLOCK
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
PR
8 GATE
C TANK
ABOVE APPROVAL$ 00 NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
PAGE 02