0008-078 (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
6X4074 is
Date It f :,i Signature of Cont actor,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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). r
( ) I am exempt under Section B&P.C. for this reason
Date 'e 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 Y'UND Policy No. 046-00073"
(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 California, and agree that if [-should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions:
Date: Pfr 2 Applicant
fes. (w
Warning. Failure to secure Workers Compensation coverage is-u—nlawful and
shall subject an employer to criminal penalties and civil fines up to $1/00,000, 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 authorize representatives of this City to enter upon
the above-mentioned property•for`inspectionpUrposes. r
Signature (Owner/Agent] _
• BUILDING PERMIT PERMIT#
DATE a VALUATION LOT ONS -078 TRACT
$220,852.00so 29457'1
JOB SITEj
ADDRESS .-J�•i-7 E*1AN 0 I.t1. C?i7IT�TAI DlPtld�!
APN
"94M019
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SPAU9 C'014MUTC1.T013
SPARKS CONST.IRUTCTLON
`79.295 ,RANC'110 JLA QXMT] A,, DR
79-295 RMC HO LA QUib1"d'A M
LA. QUINTA. CA -02253
LAQIUNTA CA. 92253
(760)771-1941 C1:30 2994
USE OF PERMIT
Sl[NCAX. FAMILY :DV0'&,LYW4
3FD-1..0T 30 PLAN 91 R - Pk'AMIT DOES NOT JUCLUDS, BLOCK (WALL OR
POOL 'i`5%PJAN CHECK VVE REDUCTION POR MULTIPLE ISSUANCE OF
SAME PLAN 1Y'PE.
CUSTOM CONSTRUCTION 2,633,00 OF
PORC HIPAT IO 267.00 SF
0AP,,CaCl1?ICARPORT (SFS 13,034.40
EbTIMAM CON11 Off' C01`ISTRITCFLOI;d
B2a,#3 200
PEM.T FEE MOURY
CONSTRUCTION 1 WE 101.000.41€ -000 $1,063.00
PLAN CHOCK IEE 101-000-439.318 $217.40
1..
WCH"ICALFLFr 101.000-421--000 $105,00
is,'LI?X,*TRICAL FEE 101-000-420-000 $162.01
Z'w
PLUW1Ni FNEI 101.000-419-000 $179.25
ID
STRONG MOTION FEE • RESS1D 101-000-241-000 $22.09
g
C}RAD N0 ,099 101.000.01.000 $20.00
DEVELOPER. IMPACT FEE $1,907;00
ART IN PUBLIC: K.AL`ES - R.E qr 701.000.255.000 $12,13
.. i7
kAj " *•#
90B•`TC"FTAL C=t3lnf.WRUC1109 A1+ D PLAN CICK
$3,728.38
LESS PIM1 P.AU)1im
00.00
TOTAL PMbM`1' 1'7,ES DUN NOW
$3,728338
r
RECEIPT FE -DATE
sy>-
DATE FINALED
INSPECTOR
�
29
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs %
Underground Ducts I
Forms & Footings Y
Ducts l
Slab Grade
Return Air !
Steel
Combustion Air
Roof Deck 2-1-01
Exhaust Fans
O.K. to Wrap ,}- ����_----���/1
F.A.U. i
Framing - �/�`
Compressor f
Insulation —D
Vents I
Fireplace P.L. I
Grills !
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
FinalIWKI Sf Ex
Final
POO S - SPAS r
BLOCKWAr L PPROVALS
}t
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 Zv
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
r `7 -
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
j
Temp. Power Pole
t
Underground Conduit
I
Rough Wiring
it
Low Voltage Wiring
Fixtures
Main Service
I
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 10
Utility Notice (Perm)
I