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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
1411) 74, B
Date t " �. 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.
STATE FUND 13710594
(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'pro Iv sions of'Section 3700 of,the L` bor
Code, I,shall forthwith comply with those proons.
Date:', Applicant /KS -1
% ii
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 property'for inspectionpurposes.
Signature (Owner/Agee )' Date' r
/ 1 /� BUILDING PERMIT PERMIT# CONT
9609-036 4061
DATE SDA ifs VALUATION LOT 1.C� 1' I 1 TRACTa52-I
?T _
JOB SITE UMO CtiRN-11 Q.
APN :649-1•1WO35
ADDRESS
OWNER
CONTRACTOR / DESIGNERENGINEER
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1,:A. t a111�P1'.t1 CA 92253
LA O1J'tNEA CA 92253
77 1 - I+);11
(614071-1941 C�f.tl 2�11i
P( KDgt.JiK-CLZA1 1A.t,., INC.
USE OF PERMIT
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PLAN I I'AL-r CIC) `t'itJV •`C 27952.1
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5465.74 P17.!i- A(ARt,f'1!• E'NIT W1.111(Y-1@041110TV DEVELOPMENT
"l f,`,i'f'OR6 re�NS'1 tt3r7`c�',f 3,46 00 St
K)RCI-11PATTO 335,00 N',F
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;''1.AN C14F.M' 1. 1. 101-000-419-118
C01.4191'itXTIONFIX, 101-IMAIR-000
fYi HAIJ:tGA,G:1 L 1014 0-421--000 $143.50
5 €:1(:` RIC'AL. !f!!•F.Ki1)•4lil•t)f1U $213.44
PLUMBINGi'•'5�` to 1 -000"41;' -ow
,5VDW,* i14.0TWA4 ME _ ftt:SID 101-•000-241-000
GRAIDIN+ 11-�trs 101.0*443.000
4.NMRAS'Ii'I: X. ,TURR FIE 2?,5-000- 43 �3, 42 ! fi,i313F+.�10
PRVt~1SE. 1"LA14 101.00.441.34: 525.00
r\;12'i' [i.� Pi1SLtt: r I:��C,`E. - Fil .ifi� ?i}1-i'tCn7 i i w�Ii)ii $4615..74
A1t'1' fN _I"A1AC'P1..q.C.V$ - RESIO 701-160[1.255-000 -5465.74
to, UI I 'AL CONSTRUCTION ANO PLANT CH -EC ,
LESS :1 k-E-PAIT) V,BP..S
44,65.114
RECEIPT
DATEBY
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Temp. Use of Power
t
Final
Utility'Notice (Perm)
Owner
CITY OF LA OUINTA
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
T.D. DESERT DEVELOPMENT
Contractor SPARKS CONSTRUCTION
Permit Number 9609-036
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS ��CAR fEL CIRCLE
n
lq- t)c�4� '.i 1..1.
SFD PLAN 1 LOT 11
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 SIGNEC
CONCRETE SLAB - l
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST f
HEATING & VENT- A/C
FIREPLACE
i ROOF -
BOND BEAM
O.K. TO WRAP L - C
GROUT ❑ 4' Cl 8'
FRAMING L •,�
INSULATION —�
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
'ELECTRICAL
PLUMBING
FINAL GAS TEST
i HEATI NG - A/C %
HOUSE NUMBERS _
JOB COMPLETED E, 2- 11-)
7EMP•;'0WER
L ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
.1/96 TURN ON UTILITIES OR OCCUPY BUILDING