0008-036 (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 /' " Signature of Contractor
OWNER -BUILDER DECLARATION r '
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 Sectiori 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 haveand 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 STATEpUND Policy No. 096-0t>9i333
(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..l`should become
Subject to the workers' compensatio,nn. pro i`slons of,.Sg tion 37Q0 of the Labor
Code, I, shall forthwith comply with those provisions.
Date: y`� Applicant
Warning: Failure to secure Workers 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 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 for insp`ectio�purposes;,.,-''- f r
Signature (Owner/Agent) Date
t
BUILDING PERMIT PERM'T#
DATE j ! VALUATION ,LOT, TRACT
$2M,117.108 2.9457-1
JOB SITE
ADDRESS 79_W ramC)RO LA. Q(JXN-. ',A. DYHW
APN
(49-100-019
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SPARKS S C014SIRRUC rI014
SPARKS C.40113TRTUt 014
79n295.ItMC'.HO LA QU N TA DIX
79.295 Ri�.�4t,HO Lh QUWA DR,
LAQU A, CA 9.2253
LtQt!'kWrA CA 92253
(760)771-1941 CUR 2996
USE OF PERMIT
MNOLE FAMULY:aV4W.LWG
SI;'D.IA)T 9 JiLAN F,2R • PE . Wr)IDES NOT ih1C'L,UM BLOCK. WA.11, OR
P001,75% PLAN CI-I9dK.FKis_'iiZ0UC11ION FOR MtWf1PLI? ISSUANCE OF
SAMK PLAN TYPE,
C tJ Tom CONSh. `('T10N 4024.00 3F
PORCII&AT16 835.00 sip
0AIV1, LUCA1d.PO T (.7P)
ESMIATED MST OV cownRucilow
PEMWI1' FEE SIMMAR'Y
COFII#'iRUCTIO14 FEE 101,000-418-000 $1,133.09
PLAN CHECK t''EE 101-000-439-316 $832.34
- 3
MECHANICIAL 101,000-421-000 Y130150
,7
ELEC"1JU AL FEE' 101.000-420.000 $189.24
PLUMBING FLEE 101.000.419.000 $175.77
STRONO MOTION IEE - 9"M 101-000-241-000 $84,01
1 "j
ORAMNO FEE 101.000.423.001 00100
DEVELOPER IMPACT FEE $1,907:410
r • �. � , ,
ART IN PUBLICS PLACEa - RESIr 701.000-ZSS-000 9100.29
h
"9f
911B-TMAL C014MUC; 1014 AND PI AN CiDXX
�3,i1S2.0:1
LEW Atli Plait 3 . r
$0.00
I.Mr-AL PKRW11FXr6 DUE NOW
RECEIPT
DATE
DATE FINALED
INSPECTOR
. a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�/�
Underground Ducts
Forms & Footings
6G 1
Ducts
Slab Grade
— ��
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
�G— /_�/
Vents
Fireplace P.L.
1
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
/
_
Final
POOLS -SPAS
BLOCKINALL 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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/ _'7
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
fez '"19 i—zr—
Final
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
S
Final
Utility Notice (Perm)