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0008-085 (SFD)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. O ch License # Lic. Class p. Date �LU i 9V�409 4 B 1/ oZ r-- Date fl c Signature of Contract • r J VCID OWNER -BUILDER DECLARATION LU LU I hereby affirm under penalty of perjury that I am exempt from the Contra(tor's ~ U) License Law for the following reason: N Z_ ( ) 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). C•`) () 1 am exempt under Section B&P.C. for this reason LO N Date Signature of Owner ON rn WORKER'S COMPENSATION DECLARATION C) CC Z I hereby affirm under penalty of perjury one of the following declarations: LO Fes- O () 1 have and will maintain a certificate of consent to self insure for workers' X W .L compensation, as provided for by Section 3700 of the Labor Code, for.the mJ Q performance of the work for which this permit is issued. Q L) ( ) I have and will maintain workers' compensation insurance, as required by O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this Cc v Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. co 5 STATE FUND 046-0007338 r --p J (This section need not be completed if the permit valuation is for $100.00 or less). () I certify that in the performance of the which this permit is issued, I shall not employ any person in any ner so as o become subject to the workers' compensation laws of Calif nia, and agree hat if I s uld become subject to t e orkers' compensati n provisions of Se tion 00 f the Labor Code, I 7G rthyv�th comply wit those provisions.' Date: fApplicant Warning: Failure to secure Worker pensation coverage is u�wful 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 t0 the condltion5 and restrintinns set fnrth on hie. 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 wit and State laws relating to the building construction, and hereby '7 C" ree esep fives this City to enter pon the above-mentioned pr erty for inspec 'dn purposes. - / Signature (Owner/Agen Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 0008-085 TRACT $240,117.10 57 29457-1 JOB SITE APN ADDRESS 79-675 RANCHO LA QUINTA DRIVE 649-100-019 OWNER CONTRACTOR / DESIGNER / ENGINEER. SPARKS CONSTRUCTION SPARKS CONSTRUCTION 79-295 RANCHO.LAQUINTADR 79-295 RANCHOLAQUINTADR. LAQUINTA CA 92253 LAQUINTA CA 92253 (760)771-1941 CBL4 2996 USE OF PERMIT ' SINGLE FAMILY DWELLING SFD-LOT 57 PLAN E21Z - PERMIT DOES NOT INCLUDE BLOCK WALL OR POOL, 75% PLAN CHECK FEE REDUCTION FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE. CUSTOM CONSTRUCTION 2,924,00 SF PORCH/PATIO 235.00 SF GARAGE/CARPORT (SF) 9,212.00 ESTIMATED COST OF CONSTRUCTION 249,117.10 PERMIT FEE SUAINL RY -n CONSTRUCTION FEE 101-000-418-000 51,133.00 -_ PLAN CHECK FEE 101-000-439-315 $232.24 MECHANICAL FEE 101-000-421-000 $130.30 ELECTRICAL FEE 101-000-420-000 $169.24 -�:- PLUMBING FEE 101-000.419-000 5175,75 STRONO MOTION FEE - RESID 101-000-241-000 $24.01 GRADING FEE 101-000-423-000 $20,00 `� I -•'-i '' �I DEVELOPER IMPACT FEE $1,907.00 ART IN PUBLIC, PLACES - RES1L 701-000-255-000 $100.29 '= SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,892.03 LESS PRE -PAID FEES $0,00 TOTAL PERWI r FEES DUE NOW $3 Si92.t)_i RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs_ �� Underground Ducts Forms & Footings Ducts Slab Grade Z /7� _ Return Air Steel f Combustion Air Rif Deck 3 Exhaust Fans oe O.K. to Wrap of F.A.U. Framing ,/ Compressor Insulation Vents 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 �A FPAS POOLS - BLOCKWALZ A ROYALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines j G7' Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection _ ?� �1 Pool Cover Encapsulation Gas Piping Gas Test /��� -e ©�� Appliances Final COMMENTS: 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 Final Utility Notice (Perm) _ ,00 7 1