0008-061 (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.nils Exp. Date
6'x!4 d 4 B I v1? 01
Date fd,1 ✓y"�� Signature of Contractor
t
OWNER -BUILDER DECLARATION }
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, as owner of the property, or my employees with wages as their sole
t' 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
i
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 STATII FU-gD Policy No. 046 00i>y33
(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 shou d become
subject to tfieNworkers' compensat* provisions of Section,3700 of the Labor
Code, I shall,fort�hwith comply with'those provisions.
Date: 1 ( Applicant
Warning: Failure to secure WorkerS`Coriipensation 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 represe to atives of-th, City to enter upon
the above-mentioned property for inspection putrPoses.
Signature (Owner/Agent) \— -Date 74--oo
BUILDING PERMIT PERMIT#
DATE VALUATION ' LOT 0008-061 TRACT
. ' • $240,11.`1.10 33 29 57.1
_,
I !
JOB SITE
ADDRESS V-946 RANCHO LA QUO'IAT?P-M
APN
649^1.0"19
OWNER
CONTRACTOR/DESIGNER/EN INEER
.S;faM COl+{8'IRLif.'°i'. ON
SPARKS CONS', RUCUION
79-295 RAT010 LA QLWIADF.
79-x5%^3'�tMf'HO LAQLTMTADI2.
LA QUI TA CA 92253
LA QUbrfA CA 92253
I760j771-1941 C%Lft 2996
USE OF PERMIT
M14Gx `' F.+AWLY nWO UN
SPD -LOT 33.PL AN E7 - Pkv. (MIT DOES NOT iNCLUDX BLOCK WALL QR
FOOL. 71% PI." CHECK WE REDUC71ON FOR MULT IPLZ ISSUANCE OF
PE,
::AML PLAVI TYPE,
!1
CUSTOM CONST U'la`10N %924,00 SF
t%a3i;t;HMATIO 633.00 SF
t?6 ZAGUC,AR- PORT.(911) 4,212,00
I lz'.�/U3". ED CO$T O.1(F' CtDIV'S'I$.2�C'I HON
240,117,10
$j � �v��{pp����.( �y
S�r 1' n STYA Ai.O ARL I
CONSTRUCTION FLr 101.000.418.000 $1,133.00
PLA14 CHOCK PIW, 101-000,439-318 $232.24
'',k
MECHANICAL FER, 101.000,421.000 S130.50
ZI..ECTIU AL FEE 101-000c120-000 $169.24
PLUMBIN0 FELE 1 t;1=CT00.419-K1C10 31115.75
STRONO MOTION FEE • RESID 101-000-241-000 $24.61.
GRADINOF}EE 101.000-423.000 $20,00
J,}WFLOPE',R IMPA T FEE
AAT IN PIIBUC PLACES - RLSIE 701„000-x5$-000 SIOd, a0
� t 1 I V
MM -TOTAL C0NMRITCY10M AND PL” CHL- C'1n'.
$3,892.03
LF'.3 PRF, -PAID IMM
$0.00
RECEIPT
DATE 3
Bl,r t�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
a
Ducts
Slab Grade
Return Air
Steel
_
Combustion Air
Roof Deck
O.K. to Wrap
_ p !
_
Exhaust Fans
F.A.U.
Framing
_ �f
Compressor
Insulation
U(
Vents
Fireplace P.L.
_—
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior lath
Drywall -Int. Lath
Finalj�7
_
Final
POOLS - SPAS
BLOCKWALL APkOVALS
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
S
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
Appliances
Final
MMENTS:
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 /vi
—&-
Final
Utility Notice (Perm)