9907-026 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisi3ns of
Chapter 9 (commencing with Section 7000) of'Division 3 of the Business and
Cn
C14 UJ Professionals Code, and my License is in full force and effect.
C) License # Lic. Class Exp. Date
I r LLJ
r- CC
Z r, .0�t"e Signature of Con ra�
0
I,_ C) OWNER-BUILDE4ZECLARATION
_J L)
LU LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code)�
ce) I am exempt under Section B&RC. for this reason
LO
C4 Date Signature of Owner
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— < WORKER'S COMPENSATION DECLARATION
CL —
Z
Cc I hereby affirm under penalty of perjury one of the following declarations:
FZ 0 ( ) I haveand will maintain a certificate of consent to self 'insure for workers'
X UJ 9: compensation, as provided for by Section 3760 of the Labor Code, for the
0 _J _J performance of the work for which this permit is issued.
100 _J <
< I have and will maintain workers' compensation insurance, as required by
d Section 3700 of the Labor Code, for the performance of the work for which this
to
0) permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Canier Policy No.
5 "1
0 3 1
(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 inany manner so as to become subject to the
workers' compensation laws of California, and agr29_tbat_U_Qshould become.
subject to the workers' compensation�pr drs 0 fthe Labor
_Q�si?W ection
'od- those
C e, I s* fVthwith comply with S.
_,rision
k2Da e: --7/j/- /<7 r, Applicant 1-., 70
annir,ig: Fa`ilure to secure Workers' Co�i n coverage is -un awful and
shall rsubject 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 V06
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 arid 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 O—rqg a or insp tion purposes.
I _2
nature (OwneY�gent
/19
PERMIT #
BUILDING PERMIT 4p,%07.026
DATE,,,/, VALUATION S200.917.210 LOT (36 TRACT 2
ADDRESS 743-160 CiUSA VIDA CIRM
OWNER
DEVELOPNIEN.1
PO BOX t / 1. 6
UA QUf NTA CIA 9111,25:4
USE OF PERMIT
:50MLE FANULY DWELUNG
I
'RACTOR / DESIGNER / ENGINEER
SPARIKS C011'4STRUMIION
N-295 IiLANCHO LA QI_HNTA DR,
LA QJ_1JN,rA CA 42253
SFD - LOT 66 PLAWV11 - PI51KHT I)OES NOT 1KCLUf)E LILOCK WAU,
01111001., 7-YI/e PLAN CWCK 1�11C, RE-TILK11t)N FoR NiUIXF)PLI,
ISSUANCS 4JR SAN'IF, PLAN 7YPIT,.
01J'STOXI CON,�rl'RIJCTIONI 3�,M6.Njl SIF
KWAVPATIO S�W_00 31_�
(;ARA0rWC*A1010Wl' 693.00 SP,
E5111MATED OF CONNSTRUCTIG�-,'
PERIVdi'l, VVE, SUMMARY
CUNM.,KU0'1'ICPN1 11117
)01-000-41"h)
S1,203.00
P11, AN (14 EC I � - �T-,! F
1$2411.07
Mi t C's t A t 4 1 C rM. 118
S 124 A')
UE
�CTRICAL FEE.
10 1 4W-420-000
$205.52
PLUNIHINo F'IY;.
10 1 -000-419-000
1 �43.00
�',TR(A!40rvJ0TY-PNF7 _Rf14SIf)
101 -W -241 -MO
4-0)
GrZAP(414:0 ITFIX
101-000-423-000
fl*kASTRUCTORI: H;_11,
22-54MI-443-3,42
ART 114 PUBLIC PL ACES - RJ -:3 At" 7014)013-255-000
'�UWPYW (X]IMSTRtl(.110N ANT) PI..AN CHF.CK,
-'A WFIT
RYCAL PERMIlT VVES DUE NOMV
RECEIPT DATE BY DATE FINALED
$XJ08_04
W 00
U,108.04
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION'
DATETINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms& Footings
Ducts
Slab Grade
77 ;Ly —
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.XL1.
Framing
"C/L)
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
ShowerPans
OX. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
i
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Roudh Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub,Panels
E)derlor Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final zk/
Ublity Notice (Perm) —a4 I . AUA_�