0008-051 (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
(V W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Date
r- 13 u7
LU 6 4 4 B 7/3 O1
oZ t- Dated 62&9 Signature of Co actor /
O
r- U C:) OWNER-BUILDE DECLARATION
Hww 1 hereby affirm under penalty of perjury that I am exempt from the Cotractor's
N 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
LO
N Date Signature of Owner
ON
rn
CL Q WORKER'S COMPENSATION DECLARATION
p � 1 hereby affirm under penalty of perjury one of the following declarations:
Lo. O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W u- compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q I 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
d Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier ao STATE FUND Policy No.
� 046-0007338
C)
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 Cal' nia, d agree th I s uld become
3 subject to a orkers' compens Ion provisio s of S ion 3700 of the Labor
Code, I rt ith comply h those pr on .
Date: AppIican '
Warning: Failure to secure Workers' Compensation coverage is unlawful an
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 Safe
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 b ilding
coristruction, and hereby auth resent es of this City to en r up n
the above-mentioned prope for insp cti urpos s. /
Signature (Owner/Agent) Date r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0008-05.1 TRACT
It q $240,117.10 23 29457-1
JOB SITE
APN
ADDRESS 79-8W RANCHO LA QUINTA DRIVE
1 649-100-019
OWNER
CONTRACTOR / DESIGNER / EN INEER
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA QL7INTA DR
79-295 RANCHO LA QUINTA DR
LAQUINTA CA 92253
LAQUINTA CA 92253
(760)771-1941 CBL4f 2996
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD-LOT 23 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
GARAGE/CARPORT (SF) 9,212,00
ESTIMATED COST OF CONSTRUCTION
140,11.7,0
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 8130.50
ELECTRICAL FEE 101-000-420-000 $169.24
,
PLUMBING FEE 101-000.419.000 $175,75
STRONG MOTION FEE - RESID 101-000-241-000 $24.01
;
GRADING FEE 101-000-423-000 - $20,00Co
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
f LESS PRE -PAID FEES
$0,00
TOTAL PERMIT FEES DLTE NOW
$3,892:03
RECEIPT
DATEDATE
FINALED
INSPECTOR
L
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
' INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts i
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans i
O.K. to Wrap
F.A.U. `
Framing
Compressor ,
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls t
Party Wall Insulation
-
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
'
Final ;
Final _
BLOCKWAL A PROVALS
POOLS - SPAS 6
steel
Set Backs
Electric Bond
Footings
Main Drain i
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 J
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
L`/
Encapsulation
Gas Piping
Gas Test
Appliances
i
Final
Final
Utility Notice (Gas)
ELECTRIC9
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)
A PROVALS
2
COMMENTS:
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