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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,
W07bf
Date Signature of Contractor + +
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'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 Policy No.
g'1'A't 1 1 K)Nf3 ):3'711f9594
(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 I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions' / l
Date: / Olt? `/f%> Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful 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 representatives of this City to enter upon
the above-mentioned propertyfor inspection purposes.
Signature (Owner/,Agent)/ s) N Date
fv r7/c BUILDING..PE j�MIT PERMITy 609-0,7 CONTROL#
-)5?
DATE VALUATION LOT TRACT
JOB SITE /0-yiw tJVKA1JP111 l ilk\.,1.k
APN 1►!'/+- 1.1� 1�3
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
•1"0.1,1"S11 V 1XI VE 1."e:)1s&IDN' 1.11,
SIPAt3KSC(AMS''t UC IO;v:
P.O. FOX 1716
792.45RANCHO LA QUiNTA DR.
LA Qt IWA CA 92253
LA QUIN7'A CA 97253 �.
771-1941
C:.13i K 996
USE OF PERMIT
S1NGL9 PM11LV OWPj.,!<,t.tat:
2.1672 011i.'i'i:.`.�#.ktili;.DIC
T. 1kRT-T)R0IR ("A QU..%A
PLAN 21)ALOLC,Y-) TRA.C.1' 27942-1
PHRMIT FU3.5 R5FVr,*r AN AK'1' 1N AAAMC i°'t.+4f M05 (f1;T•;131T of
553195 1 I -A AOIit;i.:.1�.i?iNT WITH Cs.�,1�41TJ1yii"2' rrti1: J1 1 Cs1'�rl 11 j"
(NtISTOt4f CONST Y,'TION 31822-00 SF
PORCEilf'A'170 180.130 Sr.
C: rARACiEt'CARPORT 6(A.041. $F+'
N;.S'1'1M AT K0 WNT OF (A)MIA., )t:fi• ON
313,184.441
PERMIT il+'EE SUMMARY
P1, AN C°'fir,C''K F.0 101.000439.318 ti.135.30
Ct J1— i'it001.tON .F1% 101 -WO -4113-000 S i.3S'r;. S4
MFX','1ANICJU. Frili -101.0 9114,214H) 5137.00
FI.EC.Tli(CA1: FEE 101-CKH).-420.000 $227.04+
111.MkID, INQ VEE. 1 U i Lul{? 4.1 .0%wMJ6.00
VONG MOT ION FE,2 - RESID 1.01.000-241-4X10 531.x:
GkAl)R401;1i it11.0tJt1-•12:i�th) '1J►.CtO
1t�if r�A.�"1`Rt.ita i IJ12F C'4.1: 125-000441-34.2 %A)00.00
PRECISE 1'1 A.N 101-0004.11•-345 $25.00
ART 1N YU131AC Pr.Ac`'ES -.{ 8MD1, 701-000-255-000 SS32.9�
xR,r.JN'V1J11LJdKAC1%S-1i1aSIC, 74)1.400-255-0()1) -539 E�5
(.1B-'MTAL C'401W"rk(!CPION AN 0 PLAN C;1.3ECI
$9 70316
TOTAL PERR11111 *8 1
RECEIPT
DATE
BY
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
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
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
Temp. Use of Power
t
Final
Utility Notice (Perm)
COMMENTS:
a •�'' r�
_ CITY OF LA QUINTA
~ BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner
T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
Permit Number 9609-037
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-994CARMEL CIRCLE
SFD PLAN 2 LOT 12
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL -
MAIN GROUND SYSTEM
GROUND PLUMBING /
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF 2
90ND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION /
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
ENCE & GATE
SEWE SEPTIC TANK 1 - . - I/
FINALS
ELECTRICAL G
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP OWER t
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING
I= -
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
m-7012
INSPECTION REQUEST LINE
777-7153
T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
Permit Number 9609-035
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS `78-940 CARMEL-CIRCLET
`I &_( Ck o
SFD PLAN 2 LOT 10
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST 7G
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH G •- (_
POOL PRE PLASTER
�22L ff NCE & GATE
tSEWERISEPITIC TANK ?.f
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1`"�96 TURN ON UTILITIES OR OCCUPY BUILDING