9711-090 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
M License # Lic. Class Exp. Date
Lu L 67407 4 f3 J%Slt�.
��.t �
Z Date Signature of Contractor
CD0o .fr t l% C,
(D OWNER -BUILDER DECLARATION
LU W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ � License Law'for the following reason:
Z ( .) 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).
cY) () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of. Owner.
ON
0)
d Q WORKER'S COMPENSATION DECLARATION
C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
F2p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for. the
O _ Q performance of the work for which this permit is issued.
C0 Q () ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
V
J (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.t
that -if" sh'ou`d become
3 subject to the,workers' compensation provisions,of`ction 3700 of the Labor
Code, I shall forth 4th comply with those provl'llons.
of.the
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
y addition to the cost of compensation, damages as provided for in Section 3706
i 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, indemnity
& 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) C� Date—/ 1
BUILDING
PERMIT PERMI'97114PA)
CONTROL/iC
C
DATE VALUATION
VnS...C414I..� LOT f
TRACT 12611 V 6
1 ? h ,i 7
Job S1IADDRESS 79-930 CA- 11M IX0
WAY
APN 6464 AO? -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SPA RKIs("110 S,RIUCI110N
11.0. BOX 1-116
-19295 Ri.11NC IQ
LA 0,LRNI 'M. DR,
(.A.Qt31M'A.
CA, 922;x:4
LA QIANI'A
�7i;t7t'7'� I., j s4::t l
CA. 92753
Cfa1.f1 +'1'Ifi
USE OF PERMIT
SM
SOT 7, TEP.i`iAZA PL,iii 1-Pixtil
ITDOES N-C)e
OR W. R- A.IPP C REMI' O1•
$213.931'Lk COMM. DEV. 001T.; 11,t'04
til•?EC.`1;:.1� I:43 (iA.'�5¢4► i;%t:>Ft �kf1.'PI-1
�SSLIiS.
t,iJ TOX•I. CO'N.iTRUC
1100 2'.,23It.01V
9 17
fi OR01VPAX10
170.00 S"r' DEC
C" 9AI�e3&CAftxt+:►RT
3Lt6:C�U SES
0
3 199%
Cl}y-��1 T
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OU1NTA
asst.¢! saa
t ls�lmr. t! .i rw. •tY
PERMIT F SUMMARY
PLAN CHECK FE'r%
101-000439-3111 3193.611
r, f7tQ�i'� l7,f it;"1'fC�TJ PEE
11)1-(4f 0Ai-I I fi-41(10 $940
50
Is1.ED-71'XIA A1..1rFX1
f01 0tiii-t�ii? 0fit�
E67,136
1+1.,4TYvN8IN0REE
101-000-40-000 �142.i►V
V.'T`i2Cl7NG jv4(YI'ION FIZIR -t�K S)T�
lfll->l�it11{l•�$,!-svv�
:t>R,'+h
_F01 01
S 4,124.?
1
smtT T 1 PLr8 ,1C" PLAr_'E+5 - RESft;
701-000) 255•01)0 $'12119.;
A4`f,'4' fN+t1J1 LK, K.1 CPA . RESif:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
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
I Utility Notice (Perm)
03/09/1999 12:03
7607711841 SPARKS CONSTRUCTION
Cl LA QUINTA
BUILDf N ETY DEPARTMENT
-7012
` •
INSPECTION REQUEST LINE
777-7153
Owner T.D. DESERT DEVELOPMENT
I
Contractor SPARKS cQN i CTlrnN
a
Permit Number 971.1-090
.
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-930 CABRILLO WAY
LOT 7 - SFD - JOB CARD DUPLICATE FOR
RF -CONSTRUCTION ONLY
-tYPE OF INSPECTION DATE INSR
FOUNDATION & SETBACK }
MAIN
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
72=4etQzr
DON T PO CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR 4L
IIOR LATH
PRE PLASTER
FENCE & GATE
FINALS
FINAL GAS TEST - `7
HEATING - A/C
HOUSE NUMBERS
TEMP
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING