0008-054 (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
6`774074 S q ff 7l 1/01
Date ; f �f�s Signature of Contract
OWNER -BUILDER DECLARATION t
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 (Seca 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
performance of the 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 3TA.t'i; FUND Policy No. 046-00P),"
(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,-----, ree that if I should become
subject to t/e workers' compensation''provisions o�Sectio-n 3700 o the Labor
Code, I shall forthwith comply wiffthose previsions.
Date: /f .gyp/"ter Applicant''
Warning: Failure to secure W�orkers''Compensation coverage is unlam61 anti
shall subject an employer to criminal penalties and civil fines up to $100,000, Id
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 authorize representatives of this City to enter upon
the above-mentioned property for inspection pbrpos�.'�/
f
Signature (Owner/Agent) -2 Date _// /2'-O s
BUILDING PERMIT PERMIT/t
IDDIDS-0m
DATE VALUATION VA0.117,10 LOT 26
TRACT 29457•l
JOB SITEI �ci�',
ADDRESS 79 8 i? I2A1 L"'�10 ei1
APN
649-1.013.019
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SPARKS CON911tCl 11010
SPA' -Y8 CONSMU 014
79.295 RMIC110 LA QL7IWAD&
79.295 RWC1=IO LA Q'(TIlN'i A DX
LA Qt INTA CA 9,2253
LA QUINTA CA 9225 3
60>771-1941 CB1* 2996
USE OF PERMIT j
WGUE? FMAIL Y ilwku N'C1
SFDf LOT 26 PLAN 93R i PM*MI.'T DOES NOT INCIVIDE 81,OCK WALT, OR
P00615% PLAN CF1WK FER REDUCTION 1`1"OR MULTIPLE ISSUANCE OF
SAME PLAN 'TYPE.
CWTOM CONSTRUCTION ZVA4,00 9h
PORGWPATIO 235.00 SF
ta4l"OVa"ORT (SIR) 4,2UM
n""IMOAU'D CO',Yr 01r CONSTI3ITCMC:.l1i`
240,117.10
J."FIR T F", SUM14ARY
CONSTRUCTION REE 101-000.418.000 51,133,00
'PLAN CHECK YFY_ 101--000-43'9-3'18 9232,.721
MHC.H"IC.A11,. FEE 101-000421-000 513030
EIZCTRICAL FZZ 101.000-420000
PLUMBING FU 101 -NO -419-000 $175.75
STR.ONO MOTION » • PL SL13 101-000-,241-000 $24.01
C
i
OR-ADINOFEE101-000.423.000 $20,00
~
DEVELOPER IMPACT FEE 9190700
AKT IN PUSUC PLACE,'1- RME 70.1.000.255.000 9100.29
.3
S iBAVIAL COMMUCT1039 AND PT. W Cx1,-M
$3,892.03
LY03 PRE -PAD) ITES
$0,00
TOTAL PJMWr F=S DUE NOW
$3m-03
RECEIPT
DATE /
BY r J
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING. APPROVALS
MECHANICAL APPROVALS
Set Backs 9 _Underground
Forms & Footings Z/
Ducts
Ducts
i
Slab Grade -0
Return Air
Steel _
Combustion Air
!
_' _
Roof Deck c
Exhaust Fans
c
OX to Wrap _
F.A.U.
_ _
Framing Z' a _
Insulation
Compressor
Vents
[
Fireplace P.L.
Grills
[
Fireplace T.O.
Fans & Controls
[
Party Wall Insulation —
Condensate Lines
[
Party Wall Firewall
[
Exterior Lath
Drywall - Int. Lath
,I
Final / �-�-cf
BLOCKWALL AP ROYALS
Final
POOLS - SPAS
Steel
[
I
Set Backs
Electric Bond
;
Footings
Main Drain
j
Bond Beam
Approval to Cover
Equipment Location
[
'
Underground Electric
[
Underground Plbg. Test
[
Final
Gas Piping
S
PLUMBING APPROVALS
Gas Test
Electric Fina[
Waste Lines p
Heater Final
1 [
Water Piping
Plumbing Final
i5
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
i
Sewer Lateral-��
Pool Cover
[
Sewer Connection
Encapsulation
i
Gas Piping
r
Gas Test d
I
Appliances
[
Final
1
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:
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