0008-066 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
1— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
tv W Professionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
t-- du7
��� 6 4 4 B /31/ C
~o Z r,- Date Signature of Contract
O�
r- H C:) OWNER -BUILDER DECLARATION
H a r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
C () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
Cr)
Q WORKER'S COMPENSATION DECLARATION
C:, 2 Z I hereby affirm under penalty of perjury one of the following declarations:
U-) O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W !�= 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.
m 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
0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE FUND Policy No. 046-0007338
00 Z)
O
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 ma so as to becom ect to the
workers' compen ation laws of Calif Ia, an as
tha I shoul become
subject to a rkers' compensa • n provisions f S on 3700 o the Labor
3 Code, I
s% I hyt�th comply wi those provisi
Date: Vim° 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 ize rep s tativ of this City to enter upon
the above-mentioned pro erty fo ns ction po es.
Signature (Owner/Agen D�'t t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0008-066 TRACT
40 $240,117.10 38 29457-1
JOB SITE I
APN
ADDRESS 79-895 RANCHO LA QUANTA DRIVE
1 649-100-019
OWNER
CONTRACTOR/DESIGNER/EN (NEER
SPARKS CONSTRUCTI0A1
SPARKS CONSTRUCTION
79-295 RANCHO LA QUINTA DR,
79-295 RANCHO LA QUINTA DR.
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)771-1941 CBL# 2996
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD-LOT 38 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
GARAGEICARPORT (SF) 9,212.00
ESTHAATED COST OF CONSTRUCTION
�w
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $1,133,00
`J , i '-
PLAN CHECK FEE 101-000-439-318 $232.24
_, i
MECHANICAL FEE 101-000-421-000 $130,50
ELECTRICAL FEE 101-000-420-000 $169.24
`� -h
PLUMBING FEE 101-000-419-000 5175.75
t v V
STRONG MOTION FEE • RESID 101-000-241-000 $24.01
GRADING FEE 101.000-423-000 $20.00
DEVELOPER IMPACT FEE $1,907.00
ART IN PUBLIC PLACES - RESIL 701-000.255-000 $100.29
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,892.03
LESS PRE -PAID FEES
$0.00
TOTAL PERM -IT FEES DUE NOW
$23,892:03
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 30.
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
_
Insulation _�
Fireplace P.L. �%%%
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final __L - �
BLOCKWAL APPROVALS
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"
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 _p
Appliances
Final
Final z �
Utility Notice (Gas) A
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) 0i 1A2
COMMENTS: