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0008-048 (SFD)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of I- 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. V) License # Lic. Class Exp. Date Qr n 67 ^0 4 B 3 /01 o Z r- Date �� Signature of Contract r 2 to 0. � F- OWNER -BUILDER DEC RATION W W I hereby affirm. under penalty of perjury that I am exempt from the Contractor's ~ a 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 (Seca 7044, Business & Professionals Code). M ( ) I am exempt under Section , B&P.C. for this reason NDate Signature of Owner O a, IL Q WORKER'S COMPENSATION DECLARATION o cc I hereby affirm under penalty of perjury one of the following declarations: Ln H O () 1 have and will maintain a certificate of consent to self -insure for workers' X W L—L 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. Co Q U ( ) 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 LO Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier STATE FUND Policy No. 046-0007338 ao � �p 16 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' co en ation laws of Calif la, d agree t I should become Subject tot rkers' compensaC n provisi ns of ection 700 of the Labor Code, I sh f rth ith comply wit those provi i s. Date: ' Applicant Warning: Failure to secure Workers' Compensation coverage is U lawful and shall subject an employer to criminal penalties and civil fines up t0 $ 00,000, 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 thorize repr ntatives f this City to enter upon the above-mentioned pro ert for inspe Io purpo e . Signature (Owner/Agent) Date 4 AO BUILDING PERMIT PERMIT# DATE VALUATION LOT 0008-048 TRACT p $220,852.00 20 29457-1 JOB SITE I APN ADDRESS 79-800 RANCHO LA QUINTA DRIVE 649-100-019 OWNER CONTRACTOR / DESIGNER / ENGINEER SPARKS CONSTRUCTION SPARKS CONSTRUCTION 79-295 RANCHO LA QUINTADR, 79-295 RANCHO LA QUINTA DR LAQUINTA. CA 92253 LA QUINTA CA 92253 . (760)771-1941 CBL# 2996 USE OF PERMIT SINGLE FAMILY DWELLING . SFD-LOT 20 PLAN EIR - 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 GARAGE/CARPORT (SF) 12,034.40 ESTIMATED COST OF CONSTRUCTION 220,852.00 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 - - PLUMBINOFEE 101-000-419-000 $179.25 STRONO MOTION FEE - RESID 101-000-241-000 $22.09(^- GRAD11140 FEE 101-000-423-000 $20.00 DEVELOPER IMPACT FEE $1,907.00 �... -i ART IN PUBLIC PLACES - RESIE 701-000.255.000 $52.13 t cap SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,728.38 LESS PRE -PAID FEES $0.00 TOTAL PERM -IT FEES DUE NOW $3,7?8 38 RECEIPT DATE I 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 Combustion Air Roof Deck Exhaust Fans O.K to Wrap / F.A.U. Framing Q� _ Compressor Insulationj� Y Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall w Exterior Lath Drywall -Int. Lath Final �� Final C// /_�'j POOLS - SPAS BLOCKWALL A.PROVALS 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 — _� Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection —` /� Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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— 00, Temp. Use of Power Final oe— Utility Notice (Perm) U�