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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
6i4074 11i99
Date 1 r'���z 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
S yion 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:
Carver Policy No.
111TJ -1
.1 _�1111'111JNID
(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 provisions of Section 3700 of the„Labor
Code, I shall.forthwith comply with those provisions.
Date: 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.
Tcertifyinat 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 inspection purpose)
47-7
Signature (Owner/Agent) j , / _ Dated /'19
..,. L/ °--_ 1,. ,
BUILDING PERMIT PERMI97i 1-1ng CONTROL#
DATE / VALUATION 51,1g}581.S() LOT 27 TRACT )63 2
JOB SITE ADDRESS 7!M- ! i:ei�iitlielil.► Wl�►�1
APN0-1122
OWNER
CONTRACTOR/DESIGNER/ENGINEER
`''.1).;)ES1:10*);NNIS E, l'
.�,'1 ARKS Cf:",til'ftUti''l10N
11.17. Box 1716
79295 RANCHO LA QUIMPA DR.
LA {ztflMl'A CIA x22153
LA Ql_A1 rl't1 (-'A 4225:4
l7rd117ij-It)Al {'.}11.(1 t'rth)�
ti
USE OF PERMIT
SFD
�
PND
LOT 22, r ORRAZA PLAN i - r ERhti'f' DOES NOT 1N1;i UIX W.oCK Wru.us
OR Kr_tl,.. AIP1= CREDIT OF 1213.95 PER C;C?fWJ4t DEV. T:1v'DEC"13 1997
"fficK
s P4,11 il/; 2.."117011 M111A,I-1SsUH.
C,I 1 T C." LAO
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CUSTOM CONS T'k1J/.i ION :.2'11.{)1) SF
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l.rCO.
(, 'j '�` �j j s (().tn
PERMIT ■ f' CF, Sf 1�{���AR 1
PLAN CHECK FL'Fi 3193.64
Vt?N';'1'k"..1_it'IMON I -Tr $44t).5()
1ANICA1 FEE It)1-000-42140) 39R St7
&Ec1'!'R10AL Fri.E Iff1-iifK1 •l2G t)t7t; SI;�.ttt
P(JJRIAIN(3t HP 101-{1(H)-419-0(iti S1•t«.t1iT
9IVONO \#Y1'I0Nl F(11" - RMUP Ir)1-l(M-74140) X1Si 5f,
t.;1tr�;7IN(� FL7i 101.00OA23-001) S:t►,ctt►
INFR,ASTRi C-1'IJRr HE 225-000-4.13-342 S4, I -Z4.7)
ART IN PIJ131.1r: PLACIiS - 5213'05
ART 1N 0 181.TC PI,AC71i" i-101SIP, 701-000.755-()(x? _15213304
SUB01'AL CONSC'R LILT- ON ANT) PIAN C1ff?CR,
55.919.07
LESS PRE -"x1.11? FEES
4213.95
'1'tl'IAI, P11,RN11T )'r•EKS O>1 E NOW
15,705.72
RECEIPT
DATE
BY /
D E N
INSPECTOR t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
IN0CTOR
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
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
- Party Wali 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 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
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
Final
Utility Notice (Perm)
COMMENTS:
r
t
'/04/1998 10:33 619-771-1841
SPARKS CONSTRUCTION PAGE 02
cw-�2UIVTA
�n PITY OF LA QUINTA
-EDING & SAFETY DEPARTMENT
777-7012
F? �' tCC �s_�iRSPECTION REQUEST UNE
777-7163 1
T D DESERT DEVELOPMENT '
Ownwr - .
�Ih,� SPARKS CONSTRUCTION
9711-105
EPOS ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES,
Joe ADDRESS 78-780 CARRILLO WAY
LOT 22, TERRAZA PLAN 1
SFD-.PERbUT DOES NOT INCLUDE BLOCK
TYPE OF INSPEMN DATE 1 INBP.
FOUNDATION a SETBACK
MAIN GROUND SYSTEM
GROUND PLUMBING YL -!r6' C . " I !V r'
PRE-GUNITE I I
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS A GIRDERS
ELECTRICAL GROUND WORK
L 6; --i -) <<
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH GAS 8 GAS TEST -�
HEATING ✓! VENT - NC
FIREPLACE
ROOF a
BOND BEAM
O.K. TO WRAP 7'
GROUT O 4' O 8'
FRAMING
INSULATION nl
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
OAVWALL INTERIOR 4/
POOL PRE PLASTER _ I
POOL FENCE A GATE _
SEWER SEPTIC TANK
FINALS
FINAL GAS TEST ISL/ s,
HEATING - AIC
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING