0008-058 (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. Class Exp. Date
>u7,40%A B 717 01
Date /.1 } `' Signature of Contract, 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:
( ) 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.,Oroperty, 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 Section13700 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 I�tJ1 D Policy No. 046.0007.338
(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 Calif ornia;-and agree that if I should become .
subject to the workers' compensationprovisions of `Section 3700 of the Labor
Code, I shall forthwith comply with; those provisions.' L 1
Date: i"�rtr" Applicant / -
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 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 autho j2e-'representatives of this City to enter upon
the above-mentioned property for inspection purpose's)
Signature (Owner/Agent)v _� t Date f / I /V
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ONS-0.se TRACT
20 30 2945",-1
ti I ) /. 2(
JOB SITE 1 1
ADDRESS •JcJ-.dial 1_ZA.NC1i® .LA Qt+..,.,..A DR
APN
649-10"19
OWNER
CONTRACTOR / DESIGNER / ENGINEER
WAMI I COXIMRUCT1014
STI/M; S CO1,1i'MIUC`I7:t')H
7 9.295 RA14010 LA QUINTA DR
79-295 RANI M10 LA QUI%i'T'A DR,
TA QU113'lA CA 42253
LA QUINTA CA 92253
('760)771-1 941 CB114 2
USE OF PERMIT r,
*30KH-.3P FA1vi ' 1_)�7 F.L NG
SPD-IA)T 30 PLAN .9IR - PEl M44T DOES NOT INCLUDE BL OCIE; WALL OR
POOL. 75% PLAN Ci [ECK RE REDUCTION FOR MUtXTPLPf NUANCE OF f,
SAMP I':LAN 'TYPE. 7 10
I.
COMM CONSTRUCTION 2,635.06 SF
l .
PORCHWATIO 267.00 SF'
dARAGIriCARPOR`1' (S* 12,034.40
COST afY CC>i�f�"nwanow
22UR52-ce
�7�� �r �gayyE��T'�!'INA.TED
%r�.1C1N111 FRE AV1tl3lV.1dSI.R. 7�
a'1
CUMSTRUC:TION FEE 1 b1.000.41 a-000 $1,063,EW
.,:r.•e�r,,.
L'x ,.n
PLAN CHECK FEE $217.50
MEC",HAAIICAI, FEE 101.000.421.000 $105.00
9I,EC'TRJCAL FEE 101-000.420-000 $162.01
PL,IiIJiI INO ru 101.000.419-000 $179.25
STRON.I3 MOTION F+E•• RFZ10 101-000-2,11-000 In.e9
C3RAQ140 RE 101-000.423-000 $20,00
#��
DJ1?VzL,OPZR IMPACT FEE $1s90'7.00
'
ART 1N PUBLIC PLACED - PS.81L 701-000=255.000 $52.113
;IB -TOTAL COIviTll'TC`T[ON A14D PI.A,'+i C1t'h.
$3,128.38
1X M -PAID 1WZ
$0.00
RECEIPT
DATE
BY �+
DATE FINALED
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
rj
Exhaust Fans
OX to Wrap
Framing
_
_ _ ( _
F.A.U.
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
Hifi
Final
BLOCKWAL A PROVALS
Final
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
— Z ��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final 00-1
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) �'a/���
COMMENTS:
61
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
04 W Professionals Code, and my License is in full force and effect.
n M License # Lic. Class Exp. Date
r` 0LO
IZ 6 40 4 B 1 01
~o Z Date �� Signature of Contracto
O�
J U � OWNER -BUILDER DECLARATION
W w I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) 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
LO
N Date Signature of Owner
ON
M
Z WORKER'S COMPENSATION DECLARATION
C:, 2 Z I hereby affirm under penalty of perjury one of the following declarations:
U-)
FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X u1 �: 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 ( ) 1 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
Il rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
t Z Carver Policy No.
cw 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 manner so as to become subject to the
workers' coyripensation laws of Califor ' , an ree that if I s become
3
subject to)fie orkers' compensati provisions o ection 0 of t e Labor
Code, I• a rth ith comply wit those provisions
Date: �� Applicant
Warning: Failure to secure Workers ompensation coverage is unl Wful and
shall subject an employer to criminal penalties. and civil fines up to $100, 1
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 11 City, and State laws relating to the building
construction, and hereby horize epre tives of this City tWer the above mentioned pro erty for ins on rp e
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0008-058 TRACT
o $2ao,852.00 30 29457-1
JOB SITE
APN
ADDRESS 1 79-900 RANCHO LA QUANTA DRIVE
649-100-019
OWNER
CONTRACTOR / DESIGNER / EN INEER .
SPARKS CONSTRUCTION
S
SPARKS CONSTRUCTION
79-295 RANCHO LA QUINTADR
79-295 RANCHO LA QUINTA DR.
LAQUINTA CA 92253
LAQUINTA CA 92253
(760)771.1941 CBL# 2996
USE OF PERMIT
SINGLE FA ULY DVIEL7-JNG
SFD-LOT 30 PLAN EI R - 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
PORCH/PATIO 267.00 SF
GARAGE/CARPORT (SF) 12,034.40
ESITMATED COST OF CONSTRUCTION
220,852.00
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $1,063,00
—
PLAN CHECK FEE 101-000-439-318 $217.90
MECHANICAL FEE 101.000-421-000 $105,00
ELECTRICAL FEE 101-000-420-000 $162.01
PLUMBING FEE 101-000-419-000 $179.25
STRONO MOTION FEE - RESID 101-000-241-000 $22.09
GRADING FEE 101.000-423-000 $20.00
DEVELOPER IMPACT FEE $1,907.00
ART IN PUBLIC PLACES - RESIE 701-000.255.000 $52.13
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,728.38
LESS PRE -PAID FEES
$0.00
TOTAL PER -AM FEES DUE NOW
RECEIPT
DATEBY
DATE FINALED
INSPECTOR