9711-099 (SFD)U)
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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 /Ex -p. Date
Date Signature of Contractor
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OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's J
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.
(,X.1 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:
Cartier Policy No.
RPM,
1^i 101597
(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: + ; f Z Ie.Applicant 1
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
I. I
the above-mentioned property fog inspection purposes.
r �
Signature (Owner/Agent) "` Date
PERMIT# CONTROL#
BUILDING PERMIT
97 11-11!19
DATE VALUATIONS f })MS}{ %0 LOT 1(W TRACT 7 V
5
/
JOB SITE
ADDRESS 78-840 f.�►iildILLO WAY
APN 646-410.016
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1'.1.x. UliSlilt'1' M.M.1110I ,:l:F!i'
�;f°i11t1;:; Co*!tilIrI)t.1Ic7":
P.O. B01117 1679293
RANC11O 1A Qt111NTA DR.
IA QlJ191'A CA 37253
LA Qt_ IVI-iX {'A 922SJ
(760)771-19.11
USE OF PERMIT
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SOT 16, tL%212!#Zr1 PLAN 1 - PERMIT 1K 6S N+.lk 1fgC1.11rA he K'K iv,lld.3
01t Ist.Ni1,. A1111' C:IttIAT OF $213.95 PI --A CE. MM. 06-v. OCiP'C.; PLAN
,
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FE}s 02%% FOR At1J1; 1-ISSUts.
� US—, 0Xi 3r.
4
DEC 0 3 1997
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W- NTA
iiall',*!TED CONT t C�11Y
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Pii'Alk-IfT Fi+.r+'.siiMMARY
PLAN CHD;j'K FUH 131 (1(h?.•1��a_�1t{ S1'13.r�J
rf�N.'{{tt,tr,1'tnn►t~{r 1014t1f)-MRAV tWnrtt
S�;Eict1A?�sG�II. IT -1c. V)1410 -421'- W SIX ,50
Ei1.t;,-:;T 1CAI. FEE I d3-CK�(}-424-0t►u S 1r:7.ts 1
PLUM111NO FFE 101-000-411909) 314Zoo
;;'f itf)Tdf i SIMION tiN 1;:R; - R{-Stj) 10 i.f}(i4.241-tH)(1 t18 56
GIZAI)IN(l TT16 I42 0441:3-0(1() 12n.UU
fNi171A;iI?iJtrylUstliFEE 22i -0O3-443.342 S4,IZ4,71
AIVr IN 1'1101I.1t: PLArwT-3 . R.l ili; 741-�Gfi-1;+ 4i}l} $21;;.Y5
ART 1N PI)ATAC PLA(74?,S - ft{?..(t; if)1-fftl() wt!G.ty1(1 4'.X3.95,
SUB -T( A1,CONS13tI.JCT'1CtN AND PLAN t31WC9,
�5�1l9.R7
LESS P1t1?-1 AID FiiliS
-$213.95
"1't)'i'AL f'f+RN4If'f FEES DUE MAV
S5,705.72
1 1%
RECEIPT
DATE
By! `""
DINA�p
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
G
Underground Ducts
Forms & Footings
- (.
Ducts
Slab Grade
(f -
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
_
O.K. to Wrap
— (GL
F.A.U.
IV
Framing
-
Compressor
Insulation
/,6L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
-
Drywall - Int. Lath
—
Final
2
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
S r Lateral
Pool Cover
Pev*r Connection
2_
Encapsulation
Cis, 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 G
Utility Notice (Perm)
COMMENTS:
08/27/1998 10:05
619-771-1841
SPARKS CONSTRUCTION
JMF LA QUlNTA
vWOF LA OUINTA
BUIL G & SAFETY DEPARTMENT
T"_7012
FINANCE MMTION REQUEST UNE
777.7163
Owner
T.D. DESERT DEVELOPMENT
C4ntrwW SPARKS CONSTRUCTION
P"ft NuffAm 9711-099
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-840 CABRILLO WAY'
LOT 16, TERRAZA PLAN 1
SFD - PERMIT DOES NOT INCLUDE BLOCK
WALLS OR POOL
WIPE OF INSPECttON DATE INSP.
FOUNDATION d SETBACK
MAIN
PRE-GUNITE
00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB (� i
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - NC
FIREPLACE
ROOF n
O.K. TO WRAP
GROUT ❑ 4' ❑ 9'
IrywuAlwN I • G, 'L/ 91/ i -
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR 5-1 Ole.,
EXTERIOR LATH ✓,
POOL PRE PLASTER
POOL FENCE 6 GATE
SEWER SEPTIC TANK
FINALS
FINAL GAS TEST
HEATING • A/C
HOUSE NUMBERS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING