0111-226 (SFD)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
Date ,bl -, ,,! 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 foilowing 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.
( ) 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 YTATR "1"10 Policy No. t7�6-11007 �
(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,
1 shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California; -and agree that if I should become.
subject to the 7workers' compensation,provlsions of Sectiorn,.3709 of the Labor
Code, I shall forthwith comply with those provisions.
Date: P? t Applicarit
P
Warning: Failure to secure Workers' -Compensation i;overage is unlawf,Lj,1,and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. '
IMPORTANT Application is hereby made to the Director of Building and,Safety' -
for a permit subject to the conditions and restrictions set forth on his r
application.
1. Each person upon whose behalf this application is made & each person of
whose request and for whose benefit work is performed under or pursuant to _
any permit issued as a result of this applicaton agrees to, & shall, indem
& hold harmless• the City%of La Quinta, its officers, agents and employ
2. Any permit issued as a result of this application becomes null and vo
work is not commenced within 180 days from date of issuance of s
permit, or cessation of work for 180 days will subject permit to cancellati
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the buildi g
construction, and hereby atithorize representatives ofthfs City to este up n 1
t
the above-mentioned pro erty or inspection purposes.
Signature (Owner/Agent):>>
BUILDING PERMIT PERMIT#
/
DATE / VALUATION LOT 01t -226 TRACT
59
JOB SITE
APN
ADDRESS 49. 190 PA KCIF-10 7?O TE
649-41D01-007
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TD :1 4SMWr DEVEC.)OPW :r a
SPARKS CON9`C.E:ii,1'(,''T ON'
310 BOX.1711
79-2.95.1' MC 101'A QU'MIA DR.
A QU,i)+I A C 99253
LA QUIMA CA 9225
(761DY771.,194.1 C. Lfr 2996
USE OF PERMIT
14", 1
577, a LAM'SP. P. PL1 N M3. lye 2'� ilC1LN hfCi � ]tdCi.i?ISS 1$.Lri`uGi� W'6I13,:,�
P004 513,A OR DRI4llr-WAYAPPROc4AColri!.
C«iiS'1014, CONSTRUCTION 4,43.00 SF
PORCHIPATIO 522.00 SY
GAROVIC°.AFiPORT 1.448100 3p
�Xd.`- D 4;�9'€'OF C:O.i�N�'IRT C, nON
35I,3t3 .30'
��rr hh,,� yy pp,,� ���� yy �ppX�yX'ST
P19R. Vl,R'.+7;'.N.tE.Yt. �'3CJA'X1=EA.CARY
CONS°t RUCT)ON P'X X 101 -MID -418-000 $1,521.30
PIA)4 CKVIC K lr1;L 101-000-439--319 $308.76
Dltkt fl9elb13t�,%X ;Fi: 101-000-421-,000 $156.50
flt.,1• CTP.3U.,1. 2 FY, 101 -000-42(3 000 82/16.72
MiYMi ING FEZ 101 u000-41.9.000 $305.00
3PPv0X0 N(YY1O14FX9 - X ID 101-000-241-000 $115A4
GRAMM KE 101-000-4.23-000 $20.00
DEVZ1kyPE't.MPACT I'MY $1,907.00
ART 114 RESIT .2747.000.4.5-(1W 473. 7
® LMS PPS.-PMIS
$0100
'�'e TAL P OM FUS DUE HOW
DEC U b 2001
RECEIPT
DATEBY
DATE FINALED
INSPE R
I _/ -- - ,,.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION-
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 11
=/ —
Ducts
Slab Grade i i
�— �_
Return Air
Steel 1 i
—/— L
Combustion Air
Roof Deck J 1
— G
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Q
Compressor
Insulation I !�
_ Z
Vents
Fireplace P.L. J I
Grills
Fireplace T.O. I;
Fans & Controls
Party Wall Insulation ;
Condensate Lines
Party Wali Firewall I 1
Exterior Lath
Drywall - Int. Lath
ii
I j
Final H.
7e�9r_
=�
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs 11
Electric Bond
Footings ! 1
Main Drain
Bond Beam J (
Approval to Cover
I S
,
Equipment Location
1 l
Underground Electric
I I
Underground Plbg. Test
Final 11
Gas Piping
PLUMBING APPROVALS
Gas Test
_
Waste Lines I i
-- y _
Electric Final
Heater Final
Water Piping I l
_ _
—_/� `�
Plumbing Final
Plumbing Top Out I t
Equipment Enclosure
Shower Pans I j
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 11
Encapsulation
Gas Piping I
Gas Test ] J
Appliances I (
-
1 {
Final
i r
I I
COMMENTS:
I I
Final 11
`jam m
Utility Notice (Gas)
-
ELECTRICAL APPROVALS
Temp. Power Pole I I
Underground Conduit
Rough Wiring I I
Low Voltage Wiring I!
Fixtures i f
Main Service i 1
Sub Panels I j
Exterior Receptacles j
G.F.I. I I
Smoke Detectors it
Temp. Use of Power I
11
IE
Final
Utility Notice (Perm)I j