0008-069 (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
cel W Professionals Code, and my License is in full force and effect.
M License # Lic. Class Ex . Date
UJ qMP04 B 7,131, 01
oZ r— Date Signature of Contract -111
CD p r17_
J1.— 0 OWNER -BUILDER DECLARATION
WWW r- I hereby affirm under penalty of perjury that I am exempt from the Cont actor'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 riot 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).
CY) () I am exempt under Section , B&P.C'. for this reason
LO
N Date Signature of Owner
ON
rn
a Z 'ITWORKER'S COMPENSATION DECLARATION
C W I hereby affirm under penalty of perjury one of the following declarations:
Lo
p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L—L ' 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 ( ) 1 have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
't Z Carrier Policy No.
cw j STATE FUND 046-0007338
t -p
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' corppensation laws of Cali ma, nd agree that ' should become
subject to eAorkers' compensa ' n p�ovisl ns of Segg& 37 0 of the Labor
Code, I s with comply wi those provi
DaApplicant
Warning: Failure to secure Work ompensation coverage is unlawf 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 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 horize rep tative f this City to e r upon
the above-mentioned pro ert or 'ns ction ur s
Signature (Owner/Agent) atgr
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0008-069 TRACT
$240,117.10 41 2y457.1
JOB SITE
APN
ADDRESS 79_ 5 RANCHO LA QUINTA DRIVE
649-100-019
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA QUINTA DR.
79-295 RANCHO LA QUINTA DR,
LAQUINTA CA 92253
LAQUAITA CA 92253
(760)771-1941 CBL# 2996
USE OF PERMIT
SINGLE FAMILY DWELUNG
SFD-LAT 41 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
GARAGE/CARPORT (SF) 9,212.00
ESTIMATED COST OF CONSTRUCTION
240,117.10
PERMIT 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
PLUMBINd FEE 101-000-419-000 $175.75
STRONG MOTION FEE - RESID 101-000-241-000 $24.01
-•— �?
GRADING FEE 101-000.423-000 $20.00
DEVELOPER IMPACT FEE
ART IN PUBLIC PLACES - RESIE 701-000-255-000 $100.29
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,892.03
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
53,892,03
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
—p
Return Air
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K to Wrap
Framing
Insulation
Fireplace P.L.
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lat
Drywall - Int. Lath
Final
('
Final
_
—
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
�'
Neater Final
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�O-
Appliances
-/
r
Final
COMMENTS:
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)