0008-033 (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. Clas�s� Exp. Date
67+8EY/4 _;0. 1 U7/31,12C..
Date Signature of Contractor
OWNER-BUILDER-bECLARATION
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 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 FUND Policy No. 040_00Mje
(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 provisions of Section,3700tof the Labor
Code; I shall forthwith comply with. -those provislons. Jj
Date: •'r j��, Applicant
Warning. Failure to secure Workers -Compensation cove rage(s.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
appllcation.
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 represent tives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Age.nt).f �`' Date ./`
• # Fb
BUILDING PERMIT PERMTJt
-iY33
DATE VALUATION t LOT - TRACT 29457-1
i 7 yl,17,1(;
F -
JOB SITE
ADDRESS 79"��a D RANC.iii.08se�i, QVJ.FV..@.ds g.+d0 E
APN 64941* -01
OWNER.
CONTRACTOR / DESIGNER / ENGINEER
S'1yA"o coAISTRud-n w
SPARKS CONS'!`El1:IMON
79-295 P.,ANC,HO 1AQUZ7TA1�1.2. ..
79.29, RA* (W0 TA C�C>WTA DR,
LA (4TJ AiTA CA 92233
LA. QU.WrA. CA 92253
(760r771-1941 CFI.# 2996.
USE OF PERMIT
smim IT $biT.L.y'' DilJnLN.,
SITD•PLAN FAR LOT 5 •PF,x.1Aff DOES NOT 114CLUDE BLOCK WALL OR
POOL PZrA13 CHECK [SEL REDUCTION FOR ISSUAACE OF MW PLAN'
TYPE �Y .
CUSTOM CowsnE3grmo �. Z924.00 sF
PORC!"ATIO h 2:15.00 SF
fl ARAOF/CARPORT (ST) 9,212.00
ES71UU= COST OF CONSTRUCTION
240,117.10
PErd0 M SUMMARY
CO M-TRUCTION FSE 1014000.418-000 $1$1331011
PLAN CHECK FEE 101.000-434-319 $234.24
MECHANICAL FEE 101.000.421.•000
8CTR1CAL FM 101=000.420-000 0169.24
,r..
PI.ti.M iAiCi FEE! Q1-000-419000 $175,75
STRONQ MOTION FEE RM0D 101-000-24.1-000 $24.01
ORADIN4I 1,b1 OOCi�423 OOz� . $20.00
1. -
blEVELOPER IMPACT FEE
'1{
MYtriPUBLIC, P.Lt�GE$ I`:EfiIL 7.01-.000-255.000 SI06.a9
-TOTAL C'C,XSM'RtTC T10kTA1`fi:Cf K" CM, CT.K
$3,892.03
7 F.133 PRR-PAID MS
$0,09
Tma E S.SISiffr nx 's D E s o YY
3
$30203
RECEIPT
DATE
BY6'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
/�%�
Ducts
Slab Grade2
— 7 pD
Return Air
Steel
Combustion Air
Roof Deck
p
Exhaust
Exhaust Fans
OX 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
Z 3 s -
Exterior Lath
Drywall - Int. Lath
Final
_ . _
Final
POOLS - SPAS
BLOCKWA
F PPROVALS
,i
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
Sewer Connection
_,-,
'� v �/�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRIC
Temp. Power Pole
L APPROVALS
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
p
Utility Notice (Perm)