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9711-088 (SFD)CV UJ UJ Lo O � � W it C:) Z Cho H� J W U) Z M 11] GV ON U a) as Lo H' O X W LL.— mUU O a 0) ,It Z ago O Q J 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 6d0d fi i Date 17 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. (y) 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. ,i I'Ai ;1,'1.11+(11 (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, arid -agree that if I should become subject to the workers' compensation provisions of Section 3700 of the or Code, I shalkfohhwitftcomply with those, provisions. Date: 1 17 f /Applicant— Warning: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal perial ties 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 1 PERMIT # CONTROL # BUILDING PERMIT y71,.i,K DATE VALUATION iy�t><,a>iv fii► LOT TRACT 1� 5let I V ADDRESSJOB SITE 7i�- E t �1Ei1Rit.L+U WAY APN .64&41 OWNER CONTRACTOR/DESIGNER/ENGINEER !'•f). DEiSf:lt'!' E)t;lliil.' 1I'b.ls'iv'T SPAR KS CON 1 !71 G"f'tf?N 11.0. 1 IOX 1716 W29510NU 10 i_A {;.kJ1N f'A ORf LA (YANTA (`.A 92253 LA 0019ft\ CA 912;3 !76,(11771-1!1411 0131.9 2tw) USE OF PERMIT 1 SIRD t LOT S, TRR iV.. A. PLAN 2- T CKR MFF [K)ES NOT 1NCE.Pi)f, itif.t ci.. g. Celt t'(XA,. AI1�l+;�tt1A•i IAT0F $226,02 PPIZ sr'C�hfRt. DEV. C�1�' i' ; PI, u� CHECK Ffifi(� �+"On f Q1L tV11.11.1't-1SStili, U t LG; :L,i r0X1 C.`C7i i:�17�Uf:;TJ0 w a.0(► �'v12t�4tAIX1'1C) I lg.tl� }1+��/ LA UitV If°� l,l i ��AltA<:3E;rc:.rtft1'+)k'i' }iS,l7E! :ir � 1 M10.1Ii VI 1) t,t?MSTI1f!C i IDN ' 00,410-1 +sf PLAN CHI -*CV. FVh 1(114-t>RJ1i.•i:tCi.i1}S Sltr$.y! cf1N':'!'ft.11CTION fr1T 101-("1-4164") t4CR,4)Il RSSC'l t.�fL'tt; s;i.1 :''s 101.0011) X12 t -OOC S 11 LN) F1.FCCRICAL FEE si%l* P1110 0140 Fill 101-d0)41?: 41111 "i �+140h1(iTK)NI ;ir_RES[lf 101-W14241 cIq•ft1 CRADI NC i'1378 t01 -000-423-(1W S»t1,(ai 1NFRASN'RIJ01Atli.Fti! 225-000-4.13-342 SI..t4N.7� ART IN W -441.1C PLACIiS - RHSH1 701 -f1()() -255-W AR'Y Its 111141,)(' 111,A0 S- 1tr41f; 70i-()(1()-25ti40) .S;;f;.�►2 Stfft-`tq:ri'At.f;Cij+1Sf 2UGTON!%NJ:)Ilf,ANCIRECK LESS PRE: -PAID Er1s!?S w'2128.02 • ')'t')'f',�,f, !'N�;R1lil'1' ir11�„4 11)11)1, Nt}�Y - S.'S,f1i!'tt.;S2 RECEIPT DATE By / D E F N ID INSPECTOR / F 1 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION I IDATE 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 BLOCKWALL APPROVALS POOLS - SPAS 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 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Pictures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: )7711841 SPARKS CONSTRUCTION _ ClJ&AF LA QUINTA BUILDIN ETY DEPARTMENT I -7012 k INSPECTION REQUEST LINE 7'77-7153 Owner T.D. DESERT DEVELOPJI NT Contractor RPARKS CONST ITC110N Permit Number 9711-088 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 78-950 CABRILLO WAY LOT 5 - SFD - JOB CARD DUPLICATE FOR RE -CONSTRUCTION ONLY TYPE OF INSPS=N DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE $LAB PTIT 51F 17,Or_ DO NOT POUR CONCRE' ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST HEATING & VENT_- A/C FIREPLACE ROOF BOND BEAM O.K. TO WRAP GROUT L) 4' ❑ S' FRAMING I, INSULATION . PRE -ROOF COVER NO WORK DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER ELECTRICAL PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER UNTIL ALL ABOVE HAS BEEN SIGNED UNTIL ABOVE HAS BEEN NALS ABOVE APPROVALS DO NOT INCLUDE RIGHT TO j TURN ON UTILITIES OR OCCUPY BUILDING PAGE 02