0008-050 (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 4 4 B
Date Signature of Conti
OWNER -BUILDER DECLARATION
I hereby affirm.under penalty of perjury that I am exempt from the ContrIctor'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 (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. p46-0007338
(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 man as to become subject to the
workers' compensation laws of Califor ' , and a ee that if I Id become
subject to/he/Workers' compensatio provisions o Sectio 00 o the Labor
Code, I s al o with comply with ose provisions.
Dater Applicant
Warning: Failure to secure Workersompensation coverage is un wful 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 State laws relating to the building
construction, and hereby authorize re entatives of this City to ent u n
the above-mentioned pr7y for in ectio purp
Signature (Owner/Agent Date 1c
BUILDING PERMIT PERMITN
DATE VALUATION LOT 0008-050 TRACT
Q $220,852.00 22 29457-1
JOB SITE
APN
ADDRESS 79-820 RANCHO LA QUINTA DRIVE
1 649-100-019
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA QUINTA DR
79-295 RANCHO LA QUINTA DP,
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)771-1941 CBL## 2996
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD-PLAN El LOT 22 PERMIT DOES NOT INCLUDE BLOCK WALL OR
POOUDRIVEWAY APPROACH.75% PLAN CHECK FEE REDUCTION FOR
MULTIPLE ISSUANCE OF SAME PLAN TYPE.
CUSTOM CONSTRUCTION 2,635.00 SF
PORCH/PATIO 267.00 SF
OARAGEICARPORT (SF) 12,034.40
ESTIMATED COST OF CONSTRUCTION
220,852.00
PERMIT FEE SU3A3AARY
CONSTRUCTION FEE 101-000-418-000 $1,063.00
PLAN CHECK FEE 101-000-439-318 $217.90
MECHANICAL FEE 101-000-421-000 $105,00
-Q
ELECTRICAL FEE 101-000-420-000. $162.01
PLUMBING FEE 101.000-419-000 $179,25
STRONG 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
�7
w --•i
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,728.38
LESS PRE -PAID FEES
$0.00
TOTAL PFRIATIr FEES DUE NOW
$3,723.38
RECEIPT
DATE B
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
Roof Deck
�_
Combustion Air
Exhaust Fans i
O.K. to Wrap j�
-
F.A.U.
Framing
Compressor
Insulation
_ _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
.L/
/ 1s/
POOLS - SPAS
BLOCKWAL 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
_
l
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
l
��%�
Pool Cover
Sewer Connection
/
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
� l
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G,F1
Smoke Detectors
Temp. Use of Power
Final
02c��
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Utility Notice (Perm)