0106-025 (CONR)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 ^ 7 % Signature of ERContractor f
__OWN -BUILDER DE ARATION
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 "fo construct the project (Sec. 7044, Business & Professionals
Code). t
() 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 Policy No.
TAYX FUND
(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 -t6 becor ie subject to the
workers' compensation laws of California, an�A'gree that if I should become
subject to the workers' compensation provisions of Section 3 00 oft bor
Code, I shall fort with comply with th,9 prp`visions.
Date: ADDlicant
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 f
for a permit subject to the conditions and restrictions set forth o i
application.
1. Each person upon whose behalf this application is made & each per at
whose request and for whose benefit work is performed under or purs t to
any permit issued as a result of this applicaton agrees to, & .shall,. ind mnify
& hold harmless the City of La Quinta, its officers, agents and empl yees.
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 such
permit, or cessation of work for. 180 days will subject permit to canchation —
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 author representat'ves of this City to enter upon
the above-mentioned property for insp�ctiortip�ul�oses.
Signature (Owr/Ag n4) - r �� DaZ,2/z
fie
PERMIT PERMIT# :
,BUILDING
DATEn VALUATION LOTTRACT
rl
JOB SITE " ` ^'" ^^�—
APN'
ADDRESS p
a 5 ":W ;EdANCHO 1A C)�1,';�! A TYRYW&
i� II Z6Dfi.
OWNER
CONTRACTOR /DESIGNER / EN INEER
SPARKS CONS%RUC"'ffeffi
SP.f•ARXIS C.'C�NIMRI (A ICON
I'A. QU.I.it+ rA. C"A, SMS 3
LA QUINT cd-% 92233
(76U)771.1941 CB.14 2996
USE OF PERMIT
• r
COMM -DW .t IMA POOL tifOUSI? - 444 Std VV AS Pr':F APE'ROVED PLANS
P ORC'1.131"A` IO 240,00 Sst
.
CIAei'ACWCARPOM' (SP.) i0a.a
1�_A1R:k�d.M�6.A M i,� )SIF ( (110 'G.hT�AX UC1,N0
11,8.x%` .4D "
,�r�pp,��;rtA yVISI
p T}y� �����g++t� FEZ,
,il'.x'.nl(.o.L IM, Ai 7R�H'.,+ t9 aJ•Y.&3YidC.0.M1..M
. .
C'ONSTRU `1ION FEE 101.000:-11 B._000 6133 o
I
PLAN CHECK Feil I$1.417.62
MICELAMCAL FES 1031-000-42,1-000 $34,50
M=TI,, CAA, PFF 101-0100-420-000 $57.39
Yf.«41bo6EITHO me 101-060-4151-000 111214
Slvovla,it+f0vonrn-COMM IW -000-241.000 $2.50
MAMMARY l of wo O.4•23aC= $201.00
.ART ffl h>tii3L C'PL ACES < C;i"IM! 101-x,100-255-000 $59,41!
ft DVC►SIT 101 -OW -439-318 43%06
F
JUN 1 1 2dP_1 r30)11 �'rP1Uf1=0N AM-%PidAN0M. c
TO FM
425*(1001
CITY OFlAOUINTA "DULYMMU�':�M'SD MW
FINANCE DEPT
�f
RECEIPT
DATE r f
'fr_.%
BY
DATE FIN . LED
3
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.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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING A. OVALS
Waste Lines
Gas Test
Electric Final
ater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Sewer Connection /�ll��
Pool Cover
Encapsulation
Gas Piping
Gas Test
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)
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
���
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel_
Roof Deck
�_ AI
_
�j �'
Combustion Air
Exhaust Fans
O.K. to Wrap
s� /
�fC
F.A.U.
Framing
Compressor
Insulation
Z �� %
��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�!
Drywall - Int. Lath�b
_
Final
Final
POOLS - SPAS
BLOCKWAPROVALS
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
Waste Lines
(/Z��/
�%
Electric Final
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 jV1-rq/pj
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
u'
Utility Notice (Perm)
.�;i;y���''�j�ti'�it���'�^r�'i'o�" vr�y.%''�.Ke ;""(�•T... i"'�'"}{�I'�fr 1 _" j�y�y�,�`�������� •lM+�•�'�/��#^'r� �.{��r��"'�Jt'i� '�y`"`F"r�l��K>�
P.O. BOX 1504 APPLICATIO ONLY
BuildinD rr, 78-495 CALLE TAMPICO
Address �'6'O��<!' . (Yr'(/N% �/ll1� LAQUINTA, CALIFORNIA 92253
Owner ` J.
BUILDING: TYPE'CONST. GCC. GRP.��
Mailing
'
Address0-A
� `-:� i�%A.P. Number � y9%/%D — 0
City Zip Tel. f e j � ✓ `_ / C. o
G�
1�r ? z i 7 7%f /,r r/ Legal Description
Contractor Project Description h7s` ` '``� ''� fir cc /-��•rl
Address
City Zip Tel.
State Lic./ City
& Classif. � 741a7, -Il Lic. # Sq. Ft.q(,((/ No. / No. Dw.
Arch., Engr.,
Size Stories Units
,p
Designer ff�j�t ;.�� C'�i t •J ,it New i Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
CityZip State
d f (/ r -f r(''- Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I] 1, 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I'1 I, as owner of the property, am exclusively'conlracting with licensed contractors to con.
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i ] 1 am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (E100) valuation
or less.)
I certify that in the performance of thF 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this, permit is issued. (Seo. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with 'all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant —Date-
Mailing
ateMailing Address
City, State, Zip
Itimated Valuation
PERMIT MOUNT..,
Plan Chk. Dep. i f + -
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback fron- Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from''roperty Line
FINAL DATE I I rN I IN5Fb%TOR_JJ_
Issued by: i to Perm
Validated by: — 2 C
Validation:
CITY OF LA OUINTA
FINANCE DEPT
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
sCc 117, In DEV
-Ci of -La uinta
Developers Proj ect ' Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this forth to the Building and Safety. Department only
after approval. Contact applicant for resolution of conditions preventing or delaying ppproval.
Project: Commercial Pool Lot C T29457-1 -
79-600 Rancho La Quinta Drive
Applicant Contact: Sparks Construction
760-771-1941 Nolan Sparks
Application. / Circulation Date: 05/09/2001
Date
Community De a opment Department
C
Christine Di rotio, Planning Manager Date p.
Public Works Department
Steve Speer, Senior Engineer .Date
PLEASE RETURN WHEN APPROVED OR NOT APPLICABLE.
e ,
f