0008-062 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
cNI W Professionals Code, and my License is in full force and effect.
=) M License # Lic. Class Exp. Date
�du7
W 67 0 4 B 7/ 1/01
oZ r— Date Signature of Contract)"
0 �
r- U 0 OWNER -BUILDER DECLARATION
W aU I hereby affirm. under penalty of perjury that I am exempt from the Cont4r's
U) License Law for the following reason:
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).
co () I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
ON
rn
FL Q WORKER'S COMPENSATION DECLARATION
o -S Z I hereby affirm under penalty of perjury one of the following declarations:
r P O () 1 have and will maintain a certificate of consent to self -insure for workers'
X U compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
C0 Q U ( ) I have and will maintain workers' compensation insurance, as required by
O Q Section 3700 of the Labor Code, for the performance of the work for which this
fl H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
ao j STATE FUND 046-0007335
�C)
!� g (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 ner as to become subject to the
workers' co pe sation laws of Cal' rnia, and gree that if o d become
subject to he orkers' comp/entkon provisio of Se 3700 the Labor
Code, I Ith complythose rov' toDate:% Applica
Warning: Failure to secure Wor ers' Compensation coverage is u u1 and
shall subject an employer to criminal penalties and civil fines up.to $100, 00, 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 Ouinta, 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, andhereby au represe tives of this City to enter u on
the above-mentioned prop y for in ecti p rpos
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE LOT 0008-062 TRACT
/,VALUATION
Z> $240,117.10 34 29457-1
JOB SITE
APN
ADDRESS 79-935 RANCHO LA QUIN'TA DRIVE
649-100-019
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA QUIrTTADR
79-295 RANCHO LA QL7INTA DR
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)771-1941 CBL4 2996
USE OF PERMIT
SINGLE FAMILY DWELLJNG
SFD-LOT 34 PLAN E2R - 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
ES111MATED COST OF CONSTRUCTION
240,117.10
PFI= FEE SUAI ARY
1�
CONSTRUCTION FEE 101-000-418-000 $1,133.00
r'yS l •-: •,
PLAN CHECK FEE 101-000-439-318 $232.24
• i ; i
MECHANICAL FEE 101-000.421-000 $130.50
ELECTRICAL FEE 101-000-420-000 $169.24
._ "r'I f ' •:
PLUMBING FEE 101-000.419.000 $175.75
STRONG MOTION FEE - RESID 101-000-241-000 $24.01
GRADING FEE 101-000.423-000 $20.00
tJ
DEVELOPER IMPACT FEE $1,90-.7.00
ART IN PUBLIC PLACES - RESIL 701-000-255.000 $100.29
SUB -TOTAL CONSTRUCTION AND FLAN CHECK
$3,892.03
LESS PRE -PAID FEES
$0.00
TOTAL PER.IVIIT FEES DZ7E NOW
S3;892.03
RECEIPT
DATE
DATE FINALED
INSPECTOR
rpt
i.5
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
; INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
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
I
Final
Final
BLOCKWALL A ROVALS
POOLS - SPAS
steel
j
Set Backs
Electric Bond
;
Footings
Main Drain
i t
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final-
Gas Piping
,
PLUMBING APPROVALS
Gas Test
Electric Final
t
s Waste Lines
Z _ p/
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
Final t Al 4o! -
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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)
COMMtNTS:
i
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