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
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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
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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�