9711-107 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I ain 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
Date l ��^ �' Signature of Contractor "� r
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.
u,'A'!'lI 14,
IND ;37t(Y;iIrl I
(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,lf I should become
subject to the workers' compensation provisions of Section 37100 of the Labor
Code, I shall forthwit comply with those provisions. i
Date: rl 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 rep er sentatives of this City to enter,r upon
the above-mentioned property for inspectio " purl rposes, /
Signature (Owner/Agent) fl' r Date
BUILDING PERMIT PERMI9711 107 CONTROL#
DATE
j VALUATION 1K :ttiil,'R1 LOT '4 TRACT 26,384
2l 'j7
'OB SITE
/iii) CA BR11,L0 WAN'APN
446 -410 -'*Z4
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T.D. DESEI;'I' IDEVE1; .�:'.ME"I3't'
SPARKS CO."91Y:UCt'tON
P.O. BOX 1716
79295 RANIC1101.A QUINTA DR.
LA tyt( INMA (:A 1r72-15:1
I,A Q PINTA CA 92253
f7tiQ177f-19:![ (�fil.� 2'.wh
r
USE OF PERMIT
�
s '
LOT 74, i ER RALA PLAN i - PERMIT %:)ES NOT INC;LU%►t. r4,0,"K R'ALLS
QK !'(XIL. Al Ill' (,RJ )IT 01 s2 13.95 PI:R COMM. t 11W. Dlifil'.: PLAN
C1fl;�.:1C 4•T.[; {rT^.,4°o trr;rft. A)[Jf:!'I.ISSl.3Fi.
CUSTOM w,otr:>7"�.tii,"NON .2:a L00 3F-
110KC1l PKI'[o 170.fm) :34. DEC 03
1997
i[AftAOr�CAltl�')tt'f' 41 r.�Mi SP
CITY OF
i
QLD! NTA►
I s y V. l T frail CS.iST CV'U0 NSTRV Ci 100
PERMIT FEC MMA9rY R
VLAN 01 CK FER it}I flQO d?;+ -3i8 S1!03,Frt
CON;;-11vtft rfON ViT►; 1014100-1119-000 �rA1h.Sfl
NU.'CI IANICAL r -M 101 -M -4 21-M U"111. R)
ELE(:"Tlt[GAf.FEE '101-000-4210 0)0 Siti7.81
111,LIN-Ili 1NGI7HE 101-(1Q At9-0(1U St4'-',W)
41Itf rNC1 AA(I'f((lAJ F`1 1 [�}?ii(1 fill-f�f)(j �•!1-(NN1 Sf7{ G.
GRAt)1 NO I--t;f i 101.000-4423.000 S200)
fKFItASW((3 1%rKI? FEES 225 -Glia -441-342 54,1,24.71
ART 1N PURLIC PLACES - RE50' 701.1-2i5.-(}i}C+ V-1 C3.95
ART IN f>1►1kiA , PLACP : - RESW, it)t-(1E1, 25: -fM _12095
SUl3-' XIDN.I, t;ON,TfRI1CTION AND PLAN C1IFCK
fi5,-() 11). 67
LESS PRE-I'AID I ITS
4213,95
' TOTAI, PKItMI' 11 MS 131116; Nf.)!'1'"
5,5,705 72
1- PJ
RECEIPT
DATE
BY,'
DAT FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs -
Underground Ducts
Forms & Footings
Ducts
Slab Grade 1
Return Air
Steel
Combustion Air
Roof DeckL
32,7
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final 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 LF -.157 T 713-1,711Z
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 7
Ublity Notice (Perm)