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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—, Exn Date
ti iOiFl if
07/3 11 J.
da
/ ' i
Date, ' �` Signature of Contractor
OWNER -BUILDER DECLARATION 7
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.
O 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.
(VY; 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:
Cartier Policy No.
SRAM ii FU dI;) 1;7; Or r97
(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 aste-bV'corfft3 subject to the
workers' compensation laws of CaGfofnia,'-and�ree that if I shout become
subject to the workers' compensalon provisions of Section 3700 of��he Labor
Cqde, 1 shall f ith comply with: those, rovls!ons. i
/patb: � �� g�/ Applicant - �
Warning: Failure to secure Workers' Compensation'dover ge is. unlawful and
shall subject an employer to criminal penalties and civil fines up-tolt,00,000, 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 180days will subject permit to cancellation.
I certify that.l have read this application and*state that the above information is
correct. 1 agree to comply with all City, and State laws relating to the building
construction, and -hereby' authoriz%japresentatives of this City to enter' upon
the above-mentioned prope// .fdFinspecti§ prrrpUs
,nature (Owner/Agent)" , Date` ./
BUILDING PERMIT PERMIT
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DATE / VALUATION$3?,,,�;1�Ei.;Z14 LOT S TRACT 2 5154
P r
JOB SITE y�1�
ADDRESS'4 9 105 �,`.:ls,' A II FARIO
APN
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OWNER
CONTRACTOR / DESIGNER / ENGINEER
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LA r;3Cr1. n'A CA 02153
LA C;UINTA t A T2253
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USE OF PERMIT
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PFIRMIT FEE
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PLAN (JWGK FEY i•t) I 'f {3')-�1�±1_ i (� $197.ow
•
c:f w1 rfleflr",'1'TON P u 1014)(04;1i4P(MI
INJE TIA vlCA)., f;X, , Iiy) I')(){)• iil t) I1 iii} it's:.
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PLl A413l'NQ FE 161-t5w-+1w-two !k: »-f. 50 `
�'>'i'i.['�i`3!'# P1,Sf•Ya's!'�AirtWN; . azF+;�i!'i i,'ioi-t'�dP,•"��ti••S.i�M) °¢�,;?al.
OR-Ai?ll=7t:l F[A71 i i') I • Ow- !123 OKI 'r;'ZO.iur
�;I.IT:-'I,w�r'rAiJt"t'►i�1: 1'I±r':`Ipt+ttUPL. A!wYf'I
$I+dal 90
p( YA1..li'ER&11J1*F V't.I;Ii+JN DUE'NOW
1h41,�!�11
RECEIPT
DATE
By ;;_
DATE F E
INSPECTOR
��a�� �..i;�•s:p4:�
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
CLQ. LDPMG
APPROVALS
MECHAN9 CALL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- U
Exhaust Fans
O.K. to Wrap
—
F.A.U.
Framing
Compressor
Insulation
0 V
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
- r{
Final
Final _ — co
SLOCKWAL L APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLURflB01 G 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
CV
Appliances
Final
Final
Utility Notice (Gas)
ELECMCAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures ca
Main Service
Sub Panels CU /L
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power !�fJ
Final -
Utility .Notice (Perm)
COMMENTS:
An #
V-7
City of La Quinta
Building ,SE Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (619) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: Cpi%SA- 4).rL, A -to
Owner's Name:
A. P. Number:
Address(3
A
Legal Description: Tr-14rc�c 15-4- tv -.J>
City,ST, Zip:
Contractor: Sparks Construction
Telephone: -1A I -IC14/ 777�
Address: PO Box 1716
Project Description: Arr4-4"
Ciry,ST, Zip: La Quinta, CA 92253
Telephone: (760) 771-1941
State Lic. # 674074
City Lic. #: 2996
Arch.. Engr.. Designer: Anta— 6A,^q-r—L,-
Address: 4DES-rVe-Nc>
7 ItO 6. q 0
City. ST. Zip:`467 1'-
ck-
Telephone:
Construction Type: Occupancy:
State-Lic.
Project type,(c irc:14e one): ew Add'n Alter, Repair Demo
Name of Contact Person: Nolan Sparks
Sq. FL:
# Stories: —F#
Units:
Telephone # of Contact Person: 771-1941
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
0
Submittal
Req'd
Rec'd TRACKING
PERMIT FEES
Plan Sets
Ian Check submitted
11 97
41
Item
Amount
Structural Calts.
/Reviewed, ready for
porrections
�ba-
an Check Deposit
Plan
Truss.Calcs.
)Called Contact Person
ti
)Plan Check Balance
0
Title 24 Cales.
(9 -VII Plans picked up
Construction
0
Grant Deed
Plans resubmitted
jiqq
Mechanical
School Foes
Reviewed, ready to issue
Electrical
Subcontactor List
Called Contact Person
Plumbing...
Contractor Infit.
Date of permit issue
S.M.I.
Ciy Business Lie.
Grading
Workers' Comp.
InffastructureA
Planning Approval
Pub. Wks: Appr.
A
H.O--L Approval
Fire Mar. Appr.
H. Dept. Approval
A%.approval
Date of final inspection
Total Permiffees