0008-039 (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
:5j740374 11 j ,. -" 7+31./6,1
Date '7'1 �,l .E� Signature of Contractor/? f e'
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 propelty, 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 mairitain 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 STATg FL1_P;D Policy No. 046 D'00y396
(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 if I should become
subject to the workers' compensation provisio`�ns`df Section'3700 of,the Labor
Code, I shall forthwith comply with those provisions.),,
Date: /P 'G._: Applicant 1
Warning: Failure to secure Workers' Co..rppensation 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 ofof nspection purposes:7-
Diate,�--
y f y
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Signature (Owner/Agent) t - r
.w
BUILDING PERMIT PERMIT#
DATE 1 f VALUATION LOT TRACT
'11
A 1 '► - IS240,11110 29457.1
4
JOB SITE F
ADDRESS 79-'710 RAN °C�>;i LA QU��TA.DR=
APN '
649A.0",19
OWNER
CONTRACTOR / DESIGNER / EN INEEF1
SPARKS CORST 'tUC 1TON
SPARKS COITE RITC11014
79-2" RAND` IO LA QE.FJIT A:DR,
79.295 RANCHO LA QU1NMA J R_
LAQUIN:['A CA 92253
LAQUIN A CA 9.2253
("/fs0)'371•]94] i"T3i4 2996
USE OF PERMIT
SNOLE FAMLY DV&LL', G
SPE)- ,01' 1 I PLAN F3R b PERMIT ODES NOT INCLUDO ts106K. WALL OR'
POOL 755'/ PUN CHECK FEE REDUCTION FOWN ULTIPLE MSUANCE Or
SAME PLA14 T'YP9 '
CUBTOM CONSTRUCTION 2.9X00 SF
PORCH/PATIO 235.00 SIS
C' fAR.AOFJOARPOR T (0F) 9,212100
r
E.WW:A3:ED COST OF CION IUC-170M
240,117.1.0
�jOA1S'!'Is C�TIO3� M, 101.000-418.000 $111"33,00
PLAN CHECK Talo:' 101-000-439-318 $232,24.'•.7
MECHAWC AL FEE 3 01-000-42,1.000 $139.50
liwLl:CTRIC,AL IEEE .101-000-420-000 $169,2A.
PLIURj;11;10 FFIR 101-000-419-000 -419.000 1174i .7s
TRONA MOTION FEE - Y SID 101-000-241-000 $24.01
ORADDRI NER 01.000-423.000 $20,00
DDE-LOPER IMPACT FEE $1,907.
-
Al2"i.' iN PUBLIC PI. AC E.S • F;ESIL 70,1.00U-255.000 $1110,29
"»v •• "
4
SUB -TOTAL COX, J=09 Ala''{i'J�I?�'j1Lrytl�)q}CIM�y�.�7�\
$3,89(2y.01
LESS PP.E-PAID i , f 0
$0.00
A
ysy •fir. � ( yy Py��yq-pt •�•�,e•�� � •� •� (�7 `. ,y��
` '.7.f-l�l. I, 1 &�..I.Y,6.L {r R' r.s.t� XITTE 71�1gd
'b �Flxe�Ya
RECEIPT
DAT )E/
BY ,�
DATE FINALED
INSPECTOR
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
Ducts
Slab Grade
p /
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
� /D_% �
POOLS -SPAS
BLOCKWALI�
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
C8
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
,h/
Gas Test
�1
Appliances
Final
COMMENTS:
Final
1 "'
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
V
Temp. Use of Power
Final
Utility Notice (Perm) Z,���