0008-053 (SFD)LICENSED CONTRACTOR DECLARATION
rn I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14W Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class . Date
L
r— LLJr- 4 4 B 7 1
Z Date - Signature of Contr ctor
(0Ot�
J (-) C:) OWNER -BUILDER DECLARATION
HLLJaW I hereby affirm under penalty of perjury that I am exempt from the Co tractor's
rn License Law for the following reason:
Z_ ( ) 1, 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).
M () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
d Z WORKER'S COMPENSATION DECLARATION
'It CD I hereby affirm under penalty of perjury one of the following declarations:
r O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= 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.
Ib < U ( ) 1 have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
Zpermit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE FUND Policy No. 046-0007338
ao -n'
l�O
�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' compensation laws of California, and agree that if I should become
3 subject to/the/workers' compensation rovisions ction 3700 of the Labor
Code, I I forthwith comply with ose r n
s.
Date: /lw/ Applicantor s Co
Warning: Failure to secure Wmpensation coveragi 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 to laws relating to the building
construction, and hereby authorize re .6
entad es of is City to enter upon
the above-mentioned prop o p tion pu�P�/
Signature (Owner/Agen Date, n '
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0008-053 TRACT
1,
l 4 CIO $220,852.00 25 29457.1
JOB SITE
APN
ADDRESS 79-M RANCHO LA QUINTA DRIVE
649-100-019
OWNER M
CONTRACTOR/DESIGNER/ENGINEER
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA QUINTADR,
79-295 RANCHO LA QUINTADR
LAQUINTA CA 92253
LAQUINTA CA 92253
(760)771-1941 CBL4 2996
USE OF PERMIT
SINGLE FANULY DWELLING
SFD-LOT 25 PLAN E1R - 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
GARAGEICARPORT (SF) 12,034.40
ES'TEWIATED COST OF CONSTRUCTION
22b,852 f
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000
PLAN CHECK FEE 101-000-439-318 $217.90
MECHANICAL FEE 101-000-421.000 $105.00
ELECTRICAL FEE 101-000-420-000 $162.01
PLUMBING FEE 101-000-419-000 $179.25
STRONO MOTION FEE - RESID 101-000-241-000 $22.09
ORADINO FEE 101-000-423-000 $20.00
DEVELOPER IMPACT FEE $1,907.00
ART IN PUBLIC PLACES - RESIL 701-000-255-000 $52.13
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,728.38
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DITE NOW
$3;728.38
RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATEINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
.r
Set Backs
-
Underground Ducts
I
Forms & Footings
Ducts
I
Slab Grade
.�
Return Air
Steel
Combustion Air
Roof Deck
Z
Exhaust Fans
;
0. K. to Wrap
F.A.U.
Framing
_ _
Compressor
i
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
,
Exterior Lath
I
Drywall - Int. Lath
i
�i
Final
{
Final
POOLS - SPAS
;
BLOCKWAI
APPROVALS
steel
Set Backs
Electric Bond
I
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
_Ae�
Pool Cover
[
Sewer Connection
Encapsulation
[
Gas Piping
{
Gas Test
Appliances ,
{
Final
{
COMMENTS:
M
;!
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
Ufility Notice (Perm)