0008-055 (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
13 `+ r %� l//111
Date "� �` ' Signature of Contractor.,-- _ }
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 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
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 Section 3700 of the Labor Code, for the
peiiormance of [lie 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 FhID Policy No. 04641=130
(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 California; ar�d agree that-ifI should become
subject'to tl�e workers' compensation provisions of:LSection 3700 of the Labor
Code, I shalliforthwith comply withrthose provisions.
Date: i / f %,,* V Applicant__: a z { -_iI
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, tate laws relating to the building
construction, and hereby/auVRbrize representatives of -this City to enter upon
the above-mentioned property for inspection purposes
Signature (Owner/Agent) Date /f o
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
7 29457-1
JOB SITE +
APN
ADDRESS -743 itAtYCtTO.t 471A I)1QTVA:
C49 -1.031-i31.9
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
s'"Ics C:{723MU=014
SPARKS CO1`TSTRUCT1014
79-295 RA14CH0LAQUI•NTADR.
79-295r%A).4GHO LAQUJNTADR.
LA.QUINTA CA. 92253
LAQUI NTA CA 9225:
('i 60)771-1941 CBL# 2996
USE OF PERMIT
3F0 -LX) T 27 PIAN 83k a?'Ii t'iMIT DOES NOT INCLUDE BLOCK WAW, Ott..
POOL. 75% PLAN C'EI8G,K 1W, REDUCTION FOR MULTIPLE ISSUANCE OF
SAME PLAN `t'YPF.
ti
CUSTOM COl'1SMUCTION 2,924,00 OF
PORCIit' ATIO 233.00 SY
1121ARAC3WARPOPIT (SF) 9,212.00
Egr A ) C(M 01i, CO1 6MUC c)Iv
2422;317.10
PERMIT Ii' Steil Q AR Y
CONSTRUC7i0114 ' ,R 101-000.418.000 S1,Inoo
PJAH CHECK: FEE 101-000-439•315 $232.24
MYCHANICAL FEE 101-000.421.000 3130.50
ti xti
X;..ECTRICAL JOEL 101 »4100-X320-000 $169,214
PLUMB111114OFFIZ 101.000.419-000
STR.ONO MO'TJO14 FLEE; • ?SFUSII9 101-000-241-000 $24.01
OlIADINC1 Fk'•I' 101.000-423.000 $20.00
",� (," � ir.=�
DEVE ,O.PER IMPACT FEE $I,907.00
ART IN PUBLIC PLACES -11E•SI1101.000.25.5-000 $100.69
SWI Tit
SCAB -WEAL CO IST:1tLTC'I:T45N AND PI.ai1v C ,-IFP— C
`,x:5,892.03
L&M -PAID rkM
$V.00
W1 AL I'EICLY_. T FTAS 117E NOW
S302M
RECEIPT
DATE
BY",1
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
Y
Steel
Combustion Air
Roof Deck
Exhaust Fans
!;
O.K. to Wrap
_
F.A.U.
[
Framing
Compressor
j
Insulation
3
Vents
i
Fireplace P.L.
_
Grills
I[
Fireplace T.O.
Fans & Controls
I
Party Wali Insulation
Condensate Lines
Party Wall Firewall
I
Exterior Lath
Drywall - Int. Lath
_
i
I
01
Final
;
Final _
BLOCKWALL A PROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
t
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
t
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
COMMENTS:
I Final
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) 17