0008-068 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C'4 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
r-- Q L
�6fi4774 B 7/�/I
oZ t, -Date f µ Signature of Con actor
CO 0 11�
J U 0 OWNER -BUILDER DECLARATION
HWW r` I hereby affirm under penalty of perjury that I am exempt from the Contract is
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).
c') () I am exempt under Section , B&P.C. for this reason
U')
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
p � I hereby affirm under penalty of perjury one of the following declarations:
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 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
Il 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE FUND Policy No. 046-0007338
ao
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 bec subject to the
workers' co pensation laws of California, and agree if I s uld become
subject tote orkers' compensatio ovis ns ection 370 of the Labor
Code, I s I rt. Ith comply with ose pro ' ons.
Date: Applicant
Warning: Failure to secure Workers ompensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,0 0, in
addition to the cost of compensation, damages as provided for in Section 706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building an 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
�^Vip & 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 and State laws relating to the building
construction, and hereb uthorize re ese Ive of this City to enter upon
the above-mentioned p perty for'nspelieli purpo e 9
Signature (Owner/Agen Date
BUILDING PERMIT PERMIT"
DATE VALUATION LOT 0008-068 TRACT
it $220,852.00 40 29457-1
JOB SITE
APN
ADDRESS . 79-875 RANCHO LA QUINTA DRIVE
649-100-019
OWNER
CONTRACTOR / DESIGNER / ENGINEER .
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA Qj1LNTADR
79-295 RANCHO LA QUINTADR.
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)771-1941 CBL4 2996
USE OF PERMIT
SINGLE FANULY DWELLING
SFD- LOT 40 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
ESTIlIRATED COST OF CONSTRUCTION
220,852-00
PERMIT FEE SUAEVIARY
_,
CONSTRUCTION FEE 101-000-418-000 $1,063.00
PLAN CHECK FEE 101-000-439-318 $217.90
' ='
MECHANICAL FEE 101-000-421-000 $103,00
n
ELECTRICAL FEE 101-000-420-000 $162.01
"_
PLUMBING FEE 101-000.419-000 $179, 23
STRONG MOTION FEE - RESID 101-000-241-000 $22.09
---
GRADING FEE 101-000-423-000 $20.00
DEVELOPER IMPACT FEE $1,907.00
C
ART IN PUBLIC PLACES.- RESIE 701.000-255-000 $31,13
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,728.38
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DIE NOW
$3,728-38
RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE TINSPECTOR
BUILDING
APPROVALS -
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
3/-01
Return Air
Steel
Combustion Air
Roof Deck
.d
Exhaust Fans
O.K. to Wrap
Framing
�q
��'%
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I 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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
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)
COMMENTS: ,