9711-087 (SFD)N
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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
B W_1091)
Date. -�� Signature of Contractor
(
OWNER -BUILDER DECLARATION r
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.
( Q 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.
(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'ifl-should become
subject to the workers' compensation provisions of Section 37Wof the Labor
Code, I shall tortwit comply with thos p ovisions
Date: f 1 1 'f ft; Applicant t % --" 1 L'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 purposfes. l�'j
Signature (Owner/Agent)- ✓ ! -- Date' y t a+ !"7 /
BPERMIT# CONTROL#
BUILDING PERMIT
8711-t}ti'1 ^ 4'/S�
DATE / VALUATION +S I +�-�� � r LOT ,! TRACT rygtj V L
ADDRESS 7A-,%0 C' ��3�I>Fa�.�I �P xkV JOB SITE . APN 646.410-064 U
OWNER CONTRACTOR/DESIGNER/ENGINEER
•i ,ii. iw i:4wiaT :�:�j� ii' v3�I�ii.iv
P.O. BOX 17145
LA QUIN-FA CA 92253
USE OF PERMIT
Sr. D
LOT 4, int RAZAPLAh i -PKRs -iti DOE iWii f
OR. POOL. All -It' (,Kf-31'1'+;1F $20,95 PER CCoMN4.
(mr..CK. I;E(S & pii1,Oil MIJ1.111-ISSUE
Cti1J A if L'l �'`!'}►.FC"1`t!/ I(+'f'iCtLr
,9295 RANCHO LA Q(11INTA DR_
LA QlAh'('A CA 922.53
(760)771-11941 rnot 299
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1EY1'141 IAVI D (:M"i`'
PERMFF VER Fsl1MMARV
PLAN CHECK
141-ONI-43+),.z(R
S1"3+S•1
r,oNs I m(:r1()N 1.191
101 -OW -418-0m
iirl1X,3fAN1CAL 1TIs
10,140)_4411 -ow
.ii`.11C,J(t
fiLEC'FRICAL FEE,
lot -4!0042(000
$1�i7.t31
1'1,1)lblf•4i NG FEW
141-000-419-000
3142A",
`n(r)N0 MOTION FO - RF;SIF)
101.t)O(1-^clt14011
RIR V.
CiitA1)1t,1(:;1'iili
!til-(HI()-4:.�;•Otl<I
$"c�,tb►
ttvi ftA:s`17ctJti"i'i!Kt`s RiA
225-00n0-143-342
7~4,124.71
ART IN WAiL1(: 1'I,AMS-121iS11; 7fli •404.2_S5-(1()0
S21?.45
AR -117 IN 431IRI,ir, 47FS11- IMI fHi(? 5 M10
-5213 45
RECEIPT _ _ r I DATE I BY'
AND PLAN C'HEC'K.
INSPECTOR
$S,7(IS-72
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
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
03/19/1999 06:45 7607711841 SPARKS CONSTRUCTION
. i
f4k wlTY F LA QUINTA
BUILDING & SAFETY DEPARTMENT
`777-7012
INSPECTION REQUEST LINE
M-7153
Owner T_n.nE�RT DEYELOP ENT
COntrOctOr SPAPA" nv" GONS r WN
Permit Number 9711-GR'7
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOBADDRESS 7R-9KD rARRiI.I.O 3VAY
LOT 4 -.SFD - JOB CARD DUPLICATE FOR
RE -CONSTRUCTION ONLY
T11PE OF INSPECTION DATE INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SI NED
CONCRETE BLAB.
JOISTS It GIRDERS
ELECTRICAL GROUND WORK
DO NOT POOR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED i
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 6 GAS TEST
HEATING 8 VENT - A/C
BOND BEAM
O.K. TO WRAP
GROUT 0 4' Q 8
j FRAMING
{� INSULATION
PRE -ROOF
COVER NO W
DRYWALL INTERIOF
EXTERIOR LATH
POOL PRE PLASTER
FENCE d GATI
EW R SEPTIC TANI
FI
ABOVE HAS BEEN SIGNED
PAGE 03