9707-131 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
FF— 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.
C =) C) License # Lic. Class Exp. Date
r- CY to
�f J fff
~o ZZ � /bate ignature of Contractor. -
CID U 6 OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a' 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). -
cr) () I am exempt Under Section , B&P.C. for this reason
LO
N Date Signature of Owner
0 N
d Q WORKER!S COMPENSATION DECLARATION
Z
I hereby affirm under penalty of perjury one of the following declarations:
p O 1 have and will maintain a certificate of consent to self=insure for workers'
K W LIL compensation, as provided for by Section 3700 of the Labor Code, for the
nJ Q performance of the work for which this permit is issued.
QU ) I have and will maintain workers' compensation insurance, as required by
j U Q Section 3700 of the Labor Code, for the performance of the work for which this
L 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
0
g (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 becom ubject to the
workers' compensation laws of California, and agree thaw if` sh uld become
3
sub* ,eci t the workers' compensation pr isions of Section 37 of the Labor
¢ode, i s all forthwith comply with those provisionsv."
Date:In Applicant
Warning: Failure to secure Workers' Com pe ion coverage is unlawf and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
r of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made &.each person at'.
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents.and employees.
2: Any permit issued as a result of this application becomes hull and void if
workis not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the rabove information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize re Ives of this City to enter upon
the above-mentioned properly -feel ii , eection purpp lses.
ignature (Owner/Agent): r i ) ''J , ate ! { 4
ta�1
PERMIT # CONTROL #
BUILDING PERMIT
97071-131
,.5654
DATE VALUATION ti flttT.�fdx,�{) LOT{) TRACT „h,, u,
ADDRESS JOB SIYE' w4. 5 CASA, DFA, RIO
APN, 1!46-333-{ 404
OWNER
CONTRACTOR/ DESIGNER / ENGINEER
'C'Yt C 'i` C 't / !7r, 7) a
SPARKS 'CON t; •:` 91'"T7/ i
11700 Box 711
19295 jZil:t AHE) LA QUii,'1'A, i. k.
1. A (11 t(I�'f'A (." A :-as? w:3
�. A
I A.i{;1[LlI1\1'r�•'�AE
9 1��>Z113
'.t,996
USE OF PERMIT
3r'C►- VENTT %.NA PLij,,i k,3. Alii itv ►l iffi ie:: %tA CRL.- IT OF
V19,211t•'im r1C:iiCikSf:J4atilgT 111J c0m, fxE V. O PT. vLA.fJ c!Ht.uK, ]�+.)?
KINK' P1) AY 75pfn rate. iN R If.'f'IPIL> ISSUE OF SAME PLA?3 TN I)r.,
ns.°$ a 11%t%TED CWT 4 t.: if CONS T RI fCf 10-N,
PEkMi . PEC �$.iA1l1 diW1
FOR:'s 101-000 -41 i4VI
felA r~rfl?C't�i.'FF
v iw�._�.i1�.i`i+` til: i � ' •.r i -:. � a�'si.:'K3,
.
_
W,j iit1NOA k,ti►:-(iGt3A_ 0_tint► 2,2
f.1f,trX#Nl[N0FF4%' 511
RTOW 1 00TIftN i?tT _ rrl -'00 •<(Afbf l_• 1tl-060$lR.7'..7
Fila, 4titl .�:z-Qls4 ` 0, 00
Ati T ;N PL lit, ES - Its Wl' 701404-.4455-000,
00,
AR"f' Ihl lrtifll,4!' I>I,af'6 �i - 1'!l: ifl� `'t)t-000-?55,()00,
PAtI,! iIESI)1.,�1ftRri;':iPfAf
4:-li$.C211,4
1'DTTE_S
1
AUG 28 1997 •nn,xt, Pc>lawrf mrs DU F N1 0 *VV
S.5%752.47
VI 1 H O [_A OrJINTA
RECEIPT .
DATE
EfY^
DATE FINALED
INSPECTOR
t
I�JSPECTIC��! RECOO�D
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BWLDWG
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
7Combustion
Air
Root Deck
Exhaust Fans
O.K.to Wrap
9
F.A.U.
Framing
j -Y _ 0`7
Compressor
Insulation
- L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
— Z
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas -Piping
Gas Test
Aa--7-
- ` - (.//2Appliances
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Mein Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final''U -•7of
Utility Notice (Perm) _
COMMENTS: