0008-065 (SFD)LICENSED CONTRACTOR DECLARATION
U) _ I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with.Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is.in full force and effect.
O =) ch License # Lic. Class 'Exp. Date
�0LO
6/404 B 7131/01
oZ � Date ��� Signature of Contr for
O1-
rtU 6 OWNER -BUILDER DECLARATION
W W r1_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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).
M () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
0)a_ Q WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
LO O ( ) I have and wilt maintain a certificate of consent to self -insure for workers'
X W Y: 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.
CD Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
tl 0 H permit is issued. My workers' compensation insurance carrier & policy no. are:
.4' z Carrier Policy No.
cp j STATE FUND 046-0007338
0
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 work for which this permit is issued,
I shall not employ any person in any man r as to become subject to the
workers' compensation laws of Californ' , and agree that if I ould become
subject to a orkers' compensation rovisio s of Sec • 370 of the Labor
Code, I s f rtoj ith comply with t se provi
Date: °/ Applicant
Warning: Failure to secure Work ompensation coverage is unlawful d
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 37 6
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 d State I s relating to the building
construction, and hereb orize epres tati s this City to ente u on
the above-mentioned p operty r ' spection p pos S.
Signature (Owner/Agent) Date
PERMIT#
BUILDING PERMIT
DATE VALUATION LOT 0008-065 TRACT
Od $220,852,00 37 29457-1
JOB SITEN
ADDRESS 79-905 RANCHO LA QUINTA DRIVE
T,649-100-019
OWNER
CONTRACTOR / DESIGNER
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA QUINTA DR
79-295 RANCHO LA QUINTA DR.
LAQUINTA CA 92253
LA QUINTA CA 92253
(760)771-1941 CBL4 2996
USE OF PERMIT
SINGLE FAAGLY DWELLING
SFD-LOT 37 PLAN EIR -PERMIT DOES NOT INCLUDE BLOCK WALL OR
POOL. 75% PLAN CHECK FEE REDUCTION FOR MULTIPLE ISSUANCE OF
SAME PLAN TYPE.
CUSTOM CONSTRUCTION 2,635.00 SF
PORCHIPATIO. 267.00 SF
GARAGEICARPORT (SF) 12,034,40
ESTIMATED COST OF CONSTRUCTION
22Q852.00.
PERMIT FEE SUMMARY
;
51,063,00
CONSTRUCTION FEE 101.000-418-000-77
-
PLAN CHECK FEE 101-000-439-318 $21-1.90
MECHANICAL FEE 101-000-421-000 $105.00
ELECTRICAL FEE 101-000-420-000 $162.01
PLUMBING FEE 101-000-419-000 $179.25
STRONG MOTION FEE • RESID 101-000-241-000 $22.09
_
(-_.'
GRADINFEE 101.000-423-000 $20.00
`•° I-' ' '-'i
DEVELOPER IMPACT FEE $1,907.00
W - i
ART IN PUBLIC PLACES - RESII 701-000-255-000 $52.13
CJ
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,728.38
LESS PRE -PAID FEES
$0.00
TOTAL PER= FEES DUE NOW
"K;728.38
RECEIPT
DATEBY
DATE FINALED
INSPECTOR
Co
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
,I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
/�
Underground Ducts I
Ducts !
Slab Grade
— ��
Return Air
Steel
Combustion Air [
Roof Deck
j -. �/ _
Exhaust Fans 1
O.K to Wrap
F.A.U.
Framing
Insulation
_
/�tel
Compressor ; I
Vents i
Fireplace P.L.
Grills f
Fireplace T.O.
Fans & Controls r
Party Wall Insulation
Condensate Lines ;
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
I
Final
BLOCKWAL A PROVALS
Final r
POOLS -SPAS
steel
Set Backs
Electric Bond I
Footings
Main Drain
Bond Beam
Approval to Cover ;!
Equipment Location
Underground Electric
Underground Plbg. Test i
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final l
Waste Lines
_
Heater Final ; f
Water Piping
Plumbing Final ;
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover i
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_
Appliances
I
Final
COMM PTS:
Z—Za—
E
j
j
1
a�
Final
Utility Notice (Gas)
ELECTRICA 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)