0008-067 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
FF— 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 = M License # Lic. Class Exp.
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w � ' 6 4CO4 B 7, 1/01
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O Date �� ' ' D Signature of Contracto
r- 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:
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
LO
N Date Signature of Owner
ON
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a Q WORKER'S COMPENSATION DECLARATION
p < cc I hereby affirm under penalty of perjury one of the following declarations:
U')
F- 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
Om _ Q performance of the work for which this permit is issued.
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
d 0)Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE FUND Policy No. 046-0007338
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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 ner s s to become subject to the
workers' co pensation laws of Cali nia, and agr that if .I sh Id become
3 subject to a y�orkers' compensa ' n provisions of S ction 37 o the Labor
Code, I ff ith comply wit those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is u wful and
shall subject an employer to criminal penalties and civil fines up to $100,00 ,
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.
(.certify that I have read this application and state that the above information is
• correct. I agree to comply wit Ciry, and State laws relating to the building
construction, and hereby �insp
rizrativ of is City to ent r on
the above-mentioned pro rty purpo
Signature (Owner/Agent) Date /C'
BUILDING PERMIT PERMIT# -
DATE VALUATION LOT 0008-067 TRACT
11 $240,117.10 39 29457-1
JOB SITE I
APN
ADDRESS 79-885 RANCHO LA QUINTA DRIVE
649-100-019
OWNER
CONTRACTOR/DESIGNER/EN (NEER
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA QUINTADR
79-295 RANCHO LA QUINTADR
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)771-1941 CBL# 2996
USE OF PERMIT
SINGLE FANELY DWELLING
SFD-LOT 39 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
PORCHIPATIO 235.00 SF
GARAGEICARPORT (SF) 9,212.00
ESTIMATED COSI' OF CONSTRUCTION
240,117.10
PERAdaT FEE SUMMARY
CONSTRUCTION FEE 101.000-418-000 $1,133,00
PLAN CHECK FEE 101-000-439-318 $232.24
MECHANICAL FEE 101-000.421-000 $130.50
='
ELECTRICAL FEE 101-000-420-000 $169.24
PLUMBING FEE 101.000-419-000 $175.75
STRONG MOTION FEE - RESID 101-000-241-000 $24.01
„7 1
GRADI'NG FEE 101-000-423-000 $20,00
f -t7
DEVELOPER IMPACT FEE $1,907.00
ART IN PUBLIC PLACES - RESIL 701.000-255-000 $100.29
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SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,892.03
LESS PRE -PAID FEES
$0.00
TOTAL. PFR1INN LST FFFS D19F TJOW
iii fi92;(l3
RECEIPT
DATE
B
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
r�
Underground Ducts
I
Forms & Footings /''� Q" -'J
Ducts
Slab Grade
Return Air
?
Steel
Combustion Air
Roof Deck
Exhaust Fans
[
O.K to Wrap 2 7 O /
F.A.U.
i
Framing /o
Compressor
Insulation
Vents
E
Fireplace P.L.
Grills
[
Fireplace T.O.
Fans & Controls
f
Party Wall Insulation
Condensate Lines
[
Party Wall Firewall
i
Exterior Lath
.Drywall - Int. Lath
'f
Final�Z/2�
Final
POOLS - SPAS
;
BLOC- ALL APPROVALS
Steel
Set Backs
Electric Bond
I
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
[
Underground Electric
'I
Underground Plbg. Test
{
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines —
Heater Final
I
Water Piping
Plumbing Final
[
Plumbing Top Out
Equipment Enclosure
I
Shower Pans
O.K. for Finish Plaster
;
Sewer Lateral
Pool Cover
r
Sewer Connection��
Encapsulation
Gas Piping
Gas Test
Appliances
Final
;
COMMENTS:
Final _
7i_�
Utility Notice (Gas)
ELECTRICAL APPROVALS
I
Temp. Power Pole
I
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
{
Exterior Receptacles
;
G.F.I.
Smoke Detectors
'
Temp. Use of Power
'i
Final
Utility Notice (Perm)