9711-098 (SFD)9 -
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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
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.
TAPE's i UN, I3;1095W
(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,bec mo e,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.forthwit comply with those•provisions. L -✓�
Date: 11. I 'N f `/ Applicant !�' 1 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
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)""''F �+ � � Date I 2
BPERMIT# CONTROL#
BUILDING PERMIT
,J ! ! !-tH11i
DATE VALUATION �18 S.S+yI�, LOT 1 TRACT .-375
� 7 5
(~ � �7
ADDRESS n.xii) (�tiRRIIAX) `SAY JOB SITE
APN .646410-015
OWNER
CONTRACTOR/DESIGNER/ENGINEER
"ARK"
P.Ci, BOX 1716)
?929:5 R NCii0o I.A. QUINN-tIA DR_
LAQUINTA t;A 92253
1,A QOINTA CA 92251
f'7((t1?71.194I t: #A1.# 2996
f f
USE OF PERMIT
LOT t5. TERRAr QL K.AN i - R'I;Itlti iT I}OLS t+it. P 1t4CI iJT)ii (IL0CX K'f�S
OR fN 1C:N.. All IP CREDIT CJI :S2J'.% 95 Pik CO&Iht. DUV. I>h:I''t',: t1I..AN � I
FFX (71 t' a FOR tN[If,'I'i-IS'iil? , 1
DEC 0
3 1%7
CUXI'0.'ii ::ONS RRIC 100
F'OItC,'iiI'ATTG 470.00 81- TY'
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QUINTA
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.rw7'A 11t f1•L i1JiJ C037041? i.0 N371 ill. CF.110N
R 81%53 1.910
PERMIT FCC StJMilir' RV
P1, AN $01 LFf,% FHE
Cy.)NITURI rC11014 FEE, IM -f" -.1184M 5u si1. Vit)
Itl2iCIIANICAi.l F I�iI•iN)O�x�i-UOU S' .5t►
ELEC 1 R.ICCrU. HTM 4 41-WO.420-Wi
1111ti 4114 J F FE 101-000.419-frii(1 S 1420)
;tON(i tlr�7'rc_Nf Fii:-1�I.RIf:! I{i�•t)(1(?-;'.fl.(lfi(1 C1ft,SK
Ok'AL411.10 FIT. lot -000-11.3-000 V). (KI
INPRASTRUCI'URFt TT &2W)O-44.1-34112 -44.1-342. $4,124.71
AItT IN PUBLIC 1411ACE3 - ki siT; 5213.93
if4 PIif".It; }�LY71':: - WIST ; 701-fNi{!•'.`'S IllH1 _$213 .f►5
S(JI.OKTAl. (X)Nt7R1K.TI0N ANTJ f'f,AN t~IircK
S4;J14.67
LESS I ZE-11MO i EES
42113.915
TOTALi"1~:ltINI ;w i•;1!'..� IitII:I1 O W
$5.704.72
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE I
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
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
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)
08/27/1998 10:05 619-771-1841 SPARKS CONSTRUCTION PAGE 03
..--^ter-?�-•_• . • -
F LA QUINA
,(�Y OF LA QUINTA
C �I G S SAFETY DEPARTMENT
7"-7012
' FINANCE DATION REQUEST LINE
m-7153
Owner T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
Permit Number 9711-098
POST ON J091N CONSPICUOUS PUKE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
Joe ADDRESS 78-850 CA13RILLO WAY
LOT 15, TERRAZA PLAN 1.
SFD - PERMIT DOES NOT INCLUDE BLOCK
WALLS OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION A SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING / _ : ;• .
PRE-GUNITE
00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL, GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS A GAS PEST
HEATING A VENT - A/C
FIREPLACE
ROOF
BONO BEAM
O.K. TO WRAP
GROUT G x 0 8,
FRAMING -
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS @EEN SfGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER ,
POOL FENCE 8 (SATE
SEWER $EPTIC TANK �• .� _
FINAL GAS TEST
HEATING • A/C
HOUSE NUMBEF
JOB COMPLETEI
TEMP POWER
ABOVE APPROVALS 00 NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING