0008-070 (SFD)ft 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
eCs#pw Lic. Class ,f Ex . Date eve
7/134
Date ��' {�Signature of Contractor s'
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).
( ) ••1, 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
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 STATE FUND Policy No. 046-G1tM39
(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 Calirn'aa,, and agree thaYif 1 should become
th
subject to e workers' compensation prov`slons of Section 3700 of the Labor
Code, I shall forthwith comply with/those provisions.;/' ! �'
Date:. r `�'i. or Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawfuliLd
shall subject an employer to criminal penalties and civil fines up to $100,000, In
addition to the cost of compensation, damages as provided for in Section3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representativeslof this City to enter upon
the above-mentioned property for inspection p rposes.
Signature (Owner/Agent) - Date ff !'� u `d
BUILDING PERMIT PERMITp
DATE VALUATION LOT ow"110 TRACT
I f 211,8 d 42 29457-1
JOB SITE
APN
ADDRESS 79-&A;S W010 LA QVINvTA DOW
649-1(9)-019
OWNER
CONTRACTOR / DESIGNER / EN (NEER
WARK.S C:OM8".(RUC`.i'�y X
uppim C0N&rR1JCn014
79.295:1ZA CHOLA. QUWADR.
79-295RANCHO L& QUWADIL
LA QUINTA CA 92253
LA QUJN'CA CA 92253
(760)771.1441 Mm. 2996
USE OF PERMIT
MIGIZ AMJL) ' D WLlLi$i'C1
Sl"lb-LOT 42 PI,IN Ei ji.. PERMIT DOES NOT INCLUDE I31AC:K. WA.I,L OR
POOL, 'A% PLAN CHUX .Pr1J, RZDUCTION FOR MULTIPLE ISSUANCE OF
SAME PLA14 TYPE.
CUSTOM CONSTRUC`fIQN 2,635,00 SF
PORCHIPATIO W.00 SF
0ARAWCIARPORT cff) 12,034,40
991E11t9:ATED C
220=100
PP. i MI' 1f RE 9UAfl&4R Y'
CONSTRUCTION FEE 101-MO.418.000 $1,063.00
PU1,N CHECK FEE 101-000-439-318 $217.00
MRCHANICAL",9 101-•000.4.21»000 8145.00
4..,
ELECTRICAL FU 101-000-420-000 8182.01
J, �1
PLUMB9,1 t FEE 101.000.419-000 $179.25
..,
STRONG MOTION FU - 3MID 101-000-241-000 $32.09
� r
GRADINO FElt 101.000.423.000 $20,00
.3
DLrVFWPF,RIMPACT FEE
ART rN PUBLIC PLACES < RESli 7.01.400.255.00(3 851,!3
•
�1-....7
"-7WAI. CO1JSTRLtC TLOA1' AND PLAN CI-MCK
$3,728.38
TZ 3S I'RIE-1-PA ],? now
$0.00
YO TAL FI UM MES DUE ROW
,?28,38
RECEIPT
DATE)
BY,i
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
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final —
BLOCKWALL APPROVALS
Final
Steel
POOLS - SPAS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
/�
Pool Cover
Sewer Connection
(Q
Encapsulation
Gas Piping
Gas Testi��l
6./
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:
TI e>
_
f.�
Certificate of Occqpa,
ncy
City o.f La, Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-855 RANCHO LA QUINTA DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: S-3, U-1 Type of Construction: VN
Owner of Building: SPARKS CONSTRUCTION
Building Official
Bldg. Permit No.: 0008-070
Land Use Zone: RL
Address: 79-295 RANCHO LA QUINTA DR.
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: SEPTEMBER 13,2001 `
POST IN A CONSPICUOUS PLACE