0008-071 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O ch License # Lic. ?Class p. ate
r— t3 u7
r-ofr-6404 B 7131Z I- Date / PQ Signature of Contrac
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cn O _
r- H � OWNER -BUILDER DECLARATION
W w r1_ I hereby affirm under penalty of perjury that I am exempt from the Contractles
~ t1 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 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).
C0 () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
0)d Q WORKER'S COMPENSATION DECLARATION
p CE I hereby affirm under penalty of perjury one of the following declarations:
HO () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
O J JQ performance of the work for which this permit is issued.
C0 Q U ( ) I have and will maintain workers' compensation insurance, as required by
QSection 3700 of the Labor Code, for the. performance of the work for which this
d H permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Cartier Policy No.
ob d STATE FUND 046-0007338
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 becom ct to the
workers' compensation laws of Cal' d agree that i should ecome
3 subject to a porkers. compen Ion provisio of Sect' 3700 of t e Labor
Code, I sh II f rthwith comply Ith those provisio s.
Date: -�� . Applica t
Warning: Failure to secure Wor pensation coverage is unlawful an
shall subject an employer to criminal penalties and civil fines up to $100,000, i
addition to the cost of compensation, damages as provided for in Section 370
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 wit City, and S ws relating to the b 'ding
construction, and hereby horiz epre tatives f this City to ent U on
the above-mentioned pr erty for ins Ion purpo S.
Signature (Owner/Agent at 100
PERMI
BUILDING PERMIT
0
DATE VALUATION LOT 0008-071 TRACT
$240,117.10 43 29457-1
JOB SITE
APN
ADDRESS 79-645 RANCHO LA QUANTA DRIVE
649-100-019
OWNER
CONTRACTOR / DESIGNER / EN INEER
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA QUINTADR.
79.295 RANCHO LA QUINTA DR,
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)771-1941 CBL# 2996
USE OF PERMIT
SINGLE FAMILY DWFLLIlNTG
SFD-LOT 43 PLAN E21Z - 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
GARAGEfCARPORT (SF) 9,212.00
ESTIMATED COST OF CONSTRUCTION
246,117.19 j=
PERMIT FEE SUNIIVLLRY
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
f -i -I !_J
ELECTRICAL FEE 101-000-420-000 $169.24-I
1
PLUMBING 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 $1,907.00
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 FERMHU FFFS DUE NOW
ti92_Q3
RECEIPT
DATE
BY
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
`y
Compressor
Insulation
_Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
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
— —p
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
7
Encapsulation
Gas Piping
Gas Test
GG
Appliances
Final
OMMENTS:
Final
Utility Notice
l�t' A_
(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)
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