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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„
1 YVI-) -It 1/
Date / 0 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.
STNT9 FUND
(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' compensationprovisions,ci Section 3700 of the Labor
Code, I shall forthwith comply with, those proyis ons
Date: ia1' "� 4 Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensatio 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 property forlinspectfon purposes
Signature (Own(ar/Agegl) t` Date
BUILDING PERMIT PERMIT CONTROLk
4 O 76
DATE •.'� VALUATION S-113381144) LOT �a� r '1 TRA 52-1
79
9 9 — SEE L,E6&E4 i o
JOB SITE 794. 5i.�f�d�.�'t.EL CIRCLE
APN 644'-210-03i
ADDRESS
OWNER
CONTRA'C�}OR / DESIGNER / ENGINEER
SV,Irl, DEW L0.41"MU'Nrr1r1'
S1?AR!\SCON.niTM.lf��1i3�!
RCP. BOX i _/ 16
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9295kANCHOLAQUHN AA,
LA Cj(,f1MIA CA 92253
1LA. t?.liJithit'�'t�f CA 1)275 t
771_'! 94.I
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((il �?�r?l_k�l.f7. CT3114 2996
PEK,( REK-t„T.1ANOM, INC.
USE OF PERMIT
SINN � i+`s1.WLY i:1WIxLi,1NO
23672M19:t`3C:#4Mt21J12
r A V T7 r 'Pt~ qT OA Q'. 1A
PLAN 2 PAL CK-VIRAI':1" 27+942-I
PERMIT RI_N' 10,`RXr—*r A14 ART IN
$512.95 fllt A.A:J'ItI QWi lr WITH IrCOHNUNITY Vi?'trELOPIVIENT
fJf81,0!V1 CONS Iii A: 1CON . 3".42 io s
1,10.H.C:f� * All 0 180.0 tj
0ARACIFiCr><R-PORT F+F,fi.(fl! S%'
++`t'il► �' :�a; A COST OF CON:YU#ION
{yyyMI FIER UAaNIAtV
.
.
PLAN C"kWCI' rUE IGt.�Ei�Jt}•439=�I$ S1,.I3S.3ti
co FCC 101-000-418-000 si,3913.37
h41",l:f 4VNtC.AL FbY.,4dJE�fk)lJ-�I2.i-l)ilu "Iif.t)tt
Fs1.F:fa't'filt4"AT>.I H'is. i01wU110 f2t)-C)Ut) 3227JI0
MUMDTNfrlIk 101•fl�?0 �1l�y.ClDO S„!}G.t>0
Xi'C,ifdi#MOTION wiIi-iitSSli) 101 -MM -241-000 $31.32
GRAf)iN01FRE' iql. fti1U 423-Ci0{) $210, 06
iN14RA311ti1CTf C1'P`Rr, 7>5 iK)0-443-3 42 S+i,000,00
b'i�liC:l #r R' .r'iN !Li-QOU'-.3/I1-3t� S25J0
: �i�.T IN [>Ii):'aLIC Pi.,.A(:. S •• itDSl! 701.000-;x.55-000 SSa2.'� i
4It.Y 'IN 1_1AJ #,tC I?LAGXS - RRSIT; 701.000-755-0) • $5321.95
_lRt.1O� T�AC�C,U13YT 1. C0NS"AU N
$9,10.1 f
I., *SS P.i?-1'.A[I.:) :E 1? ;S
-$532-95
RECEIPT
DATE
BY.
DATE•FINALED
INSPECTOR
INSPECTION RECORD
P,
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts G
Slab Grade _
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final -OEM
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Lateral — -
Pool Cover
%SfmWr Connection
Encapsulation
Gas Piping
Gas Test (,
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) f
06/24/1998 14:25 619-771-1841. SPARKS CONSTRUCTION
3 `E
CITY OF LA QUINTA
BUILDING 3 SAFETY DEPARTMENT
m-7012
INSPECTION REQUEST UNE
m-71 e3
O>rw T.D. DESERT DEVELOPMENT
Contrackw SPARKS CONSTRUCTION
Plwmk Nu~9609-W9
POST ON—JOB IN CONSPICUOUS PLACE
IN§PEC,TOR MUST SIGN ALL APPLICABLE SPACES
JOA ADDRESS 7S.99S CARM L .CJRCLE • •.y. •-
SFA PLAN 2 LOT 34
TYPE OF INSPtG'rom DATE INSP.
FOUNDATION & SET$ACK
FOOTING STEEL ,l
MAIN GROUND BYIITEM
GROUND PLUMBING -Z. e
SLAB
ABOVtHA$
O.K. TO WRAP
sw
GROUT O V O S'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR _IV'
TANK
FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING
.14
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