0008-047 (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
674 Bfor-
OWNER-BUILDER
\ / ?/31/O1
Date/ Signature Signature of Contra
I hereby affirm under penalty of perjury that I am exempt from the ContracSbr'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. 046-0007338
(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 manner so as to become subject to the
workers' co pensation laws of Californ, agree that if I uld become
subject to t e w rkars' compensation rovisio of Section 00 f the Labor
Code, I sh II hwith comply with tho a provisio s.
Date:'/ Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful an
shall subject an employer to criminal penalties and civil fines up to $100,000, '
addition to the cost of compensation, damages as provided for in Section 37 6
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 S ws relating to the building
construction, and hereby a repr ntatives of thi ity to enter upon
the above-mentioned prop rty for s ction purpo
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0008-047 TRACT
ICJD $240,117.10 19 29457-1
JOB SITE
APN
ADDRESS 79-790 RANCHO LA QUINTA DRIVE
649-100-019
OWNER
CONTRACTOR/DESIGNER/EN (NEER
SPARKS CONSTRUCTION
SPARKS CONSTRUCTION
79-295 RANCHO LA QUINTA DF,
79-295 RANCHO LA QUINTA DR,
LAQUINTA CA 92253
LA QUINTA CA 92253
(760)771-1941 CBL4 2996
USE OF PERMIT
SINGLE FANELY DWELLING
SFD-LOT 19 PLAN E2R - 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
ESTIlVIATED COST OF CONSTRUCTION
240,117.10
PERMIT FEE SUMMARY
E 3
CONSTRUCTION FEE 101-000-418-000
PLAN CHECK FEE 101-000-439-318 $232.24
MECHANICAL FEE 101-000-411-000 $130,50
ELECTRICAL FEE 101-000-420-000 $169.24
' l I
PLUMBING FEE 101-000-419-000 $175.73
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 - RESIL 701-000.255.000 $100.29
C-0
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,892.03
LESS PRE -PAID FEES
$0,00
TOTAL PERMIT FEES DUE NOW
$3,892.03
RECEIPT
DATE
BY
I DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION T
DATE
INSPECTOR
s
,BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs i;
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel ];
Combustion Air
Roof Deck�Q
0. K. to Wrap ; I
` /
Exhaust Fans
F.A.U.
Framing ; ►
_
Compressor
Insulation i `
Vents
Fireplace P.L.
Grills
Fireplace T.O. i t
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall i
Exterior Lath I �
Drywall - Int. Lath;
LAG'
i a
Final
� j
Final
POOL-
.SPAS
BLOCKWALL
APPROVALS
steel
Set Backs t
Electric Bond
Footings
Main Drain
Bond Beam I
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 ; 3
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral j }
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
1?e&s
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service j
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
I:
Final
Utility Notice (Perm) Gi
SPEC IAL INSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760)' 772-7192
Fax (760) 772-7193
Pager (760)' 776-3338
TYPE OF
INSPECTION
PERFORMED
�pox
❑ REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY )w . C
❑ POST TENSIONED CONCRETE ❑ ASPHALT O OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION^ 466 �u;��^
79-11D I(� � /"�I °A R , C-0.
REPORT SEQUENCE N0.
TYPE OF STRUCTURE
SFT Lor I? ENcsNroS
PERMIT N0.
DATf
2-12-10 J
DAY OF WEEK
MATERIAL DESCRIPTION -
echo• Lc� t32u�Atr/q'
ARCHITECT
INSPEC OR
�I�.
HRS. CHARGED
3i � P s o ►-� SE"l' EPQ9C E�- �Z74
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL "` " -" SUB �-
.DATE CONTRACTOR CONTRACTOR
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COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE ! OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF Md
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SIGNATURE OF. REGISTEVED
/� INSPECTOR
DATE OF REPORT REGISTER NUMBER