0008-080 (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
1674674 13 "° 7
li1/01.
/f•r �� 1. � t ,., r'
Date°'` Y i '' Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contracto/r'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 penalfy,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.
( ) 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 STATE PL44O Policy No. 0464007332
(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, an`d agree that'FY INshould become
subject to�the workers' compensation provisionsiof Section 3700 of the Labor
Code, I shall:;for ,with comply with those provision
Date: " « '' Applicant
Warning: Failure to secure Wo kers 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 Seertion 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)': Date
BUILDING PERMIT PERMIT#
DATE` VALUATION LOT 080 TRACT
-1.10
%' ,� F.4tp,1 52 29457-1
JOB SITE f
APN
ADDRESS _? itmcno jA €�Ud.IV'�`A.131!21�Y�
64EJ»3(K%t) 9
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SPARKS C`iONS'l"RUCTION
SPARKS CON: 7RUCUON
19.295 RA14CHO LA. QUiNIA DP..
79.295 1tA1`]'0101A QVINTA DR,
TA QIANTA CA, 92253
L,A QI) NTA CA. X2253
(760)771-1941 �'1 XA4# 2996
USE OF PERMIT
DWTAJ M-0.
SI'D.LOT 521; LAN 922,- PZRM1't _00" NOT INCLUVE 3ii=K.I.VA.LJ,OR
POOL. 75% PLAN C1IIWIp I`'L+I? REDUC ION FOIL Mt1I..TIPIX 1800ANCE OF
SAA+It? PLAN TY'I &
CUSTOM CONSTRUCTION Z, 24.00 OF
PORCHfPATIO X35.00 SI+
RAWCA,RPORT (91 9,21?„Ctl
7
1I:SiMt9►1XD 00ST OF c01YwrRuG°i'iow
r:
,117100
.CiLASMI8':P.(L.�+ 17V1YA.6VJLARS
CONSTRUCTION FEE 101-000.416-ounk 31,J33.00
4'
PI AN CHECK i='EF, 101-000-439-318 $232.24
Ss
MECHANICAL FEE 101-000-421-000 $130.50
y.
1
EI:ECTI7.WAL FEE 101-000-420-000 $169.24
PLUMBINO FEE 101.000-419-000
STRONG MOTI014 iceR R.ESID 101-000-241-000 $44.01
OkA.DI`N(3 FEE $20,00
DEIYEWPER IMPACT PEE $1,407.00
AWF IN PUBJU P1;,ACEB.- PIESIL 701'-000.15.5-00.0 2100.20
W11 tY)`i'A)- 00113 R.UCT 09 AI7D PLAX 0-W",,
$3,892.03
1,ESS PRF PAID .ERS
$0,00
WEAL FERN' PTEX'S DUE NOW
W.
RECEIPT ;DATEJ j
BYl�, ` /
DATE FINALED
INSPECTOR
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
F.A.U.
Framing
_
G�
Compressor
Insulation
Vents
Fireplace P.L.
%
----,,,.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
�Z-�- �
— �l �`
Final
Poor -S- PAS
BLOCKWALL PPROVALS
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
COMMENTS:
Final77
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)