9907-027 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
ter W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
w 674074 13
CC
6z tiate G /e/7 Signature of Contractor 1
O
U OWNER -BUILDER DECLARATION
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL
U) License Law for the following reason:,
Z_ ( ) 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 propdrty, 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
LO
N Date Signature of Owner
O C-4
d Q WORKER'S COMPENSATION DECLARATION
�p 4=Er I hereby affirm under penalty of perjury one of the following declarations:
Lo H O O 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
OJ Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Se 'on 3700 of the Labor Code, for the performance of the work for which this
Il rn F- permit is issued. My workers' compensation insurance carrier & policy no. are:
I ? Carrier Policy No.
r` p
(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 provisi4l]s of Section 3700 of the Labor
Code, 16 11 f hwith comply with th sg�rovisions.
tjate. �' Applicant 1
Warning: Failure to secure Workers Compensation coverage is unlawf nd
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.1s 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 ib ; -I
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereb authorize.reprgsentatives of this City to enter upon
the above-mentioned-pr�'inspe�on purposes.
Ignature (OwneY/Agent)_ Date,/
��
BUILDING PERMIT PERMITy#
07-027
DATE VALUATION %ssJ,3f;8,3J) LOT q7 TRACT
JOB SIT
ADDRES 79401 CASA VIDA CIRC IA:
APN (`49-210-00 7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
TD DEMIT D1iVE O niENu
SPARKS C"ra1\ft11%'UC'1 0N1
i•'O BOX 1716
T)- 95 RANCHO LA QUIN`i'A. DR,
1..A Qi-1IMA CA 92253
LA Q!-11N'rA C'A y2253
(766)771-1941 C EIL10 1299
USE OF PERMIT
5rl GLE PA MILY DWELIANG
S ID - LOT til PLAN NOR - PERA41T %OG.9 t401 1 UCLUDE BLOCK WALL
OR PC Jl,. 7.50/4111I..AN CHECK FEE !2L•bUC T1L. N E'c& MULITIPLE
I''S& ]ANCU OR 3A1\,W PLA_! TYPE.
CUS'rOUNICONSTiZUR.T;ON 4,213.00 SW
522.00
0ARA,0fY, :.ARP01CT llo.tio S
E.S t11IA ED CONT OF CON.'w'r ZU(:'['ION
35].3[001.30
i;'ERM1T !,-Z, &ifMMAR V
CQNSTRUC'TION > 521.511
011. A N !"Fr1;,^'t:. Vrilli 011 -fM_ -419-1 19 �3rlfi ,73
NIEC 1 11-ffil 101 1-0W 4< i- 00(11 d 13ri,,;11
t:JXC, FRICAL FEL 10 1 _000-412,10-0m S:.M6.7 i
I'L:t. N1131:NO [ZEE. 1.01 -WO -419 -ft) $;W5.00
ti-r•rrf'tNC'. fvt«�'r�'rtt F•�°I< - Rfr •.Ir) 1(11-(xxi-24j-(1{1(y x ►g,14
C ifiADING I'tiE 101-000-423-ft10
tfq kA.S`IR0CI'1lR1i 1'is)3 225 -OW -44-042 sn,twtl.u0
ART IN PL(BLIt: PLA011*3 - kA i.;1U 701-0W2554)(9)
"111'1 i'�l!°.141 C;(';rl�.'3}tUt'T'L+?N .A1•ID }'1.,n_P+i C">11?C',Kt?.;1.(1,f1y
LESS PRE -PAID FEES
"PO() -01)
"I'OT XT.. 4'8�:i;elwIT FEW—S Q)i1[+ NOW
RECEIPT
DATE
BY '
DATE FINALED
INSPECTOR
it
INSPECTION RECORD , I—
OPERATION
DATE
INSPECTOR
OPERATION
DATE —TINSPECTOR.
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts'
Forms & Footings
Ducts
Slab Grade
77--27 �n
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.KU.
Framing
Compressor
Insulation
Gtj
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
BLOCKYVALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Llnderground.Plbg. Test
Final
Gas Piping
PLUMRING 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
C XJ
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
�. CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
'roe 777-7012
INSPECTION RECUW,&NE �
m-715'31-
TD DESERT DEVELOPMEPW
Owner
Contractor SPARKS -O)NSTRTT('TT()
Permit Number 9907-027
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
J08 ADDRESS .79-1.01 CASA VIDA_CIRCLE
SFD - LOT 67PLAN M3R - PERMIT DOES
NOT INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK Z
FOOTING STEEL -
MAIN GROUND SYSTEM
i
GROUND PLUMBING
PRE-GUNITE
i
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
D_ ,SOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
' ROUGH ELECTRIC
I ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C'
FIREPLACE
ROOF OIJ
BOND BEAM
O.K. TO WRAP �?�+
GROUT [3 4' 17 8'
FRAMING '
INSULATION
PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
ENCE & GATE
eLM!Eq SEPTIC. TANK
ClUAl c
GV GV.I i v -
PLUMBING
FINAL GAS TEST
_
l NG - A/C
H..JSE NUMBERS
JOB"COMPLETED
TEMP POWER -
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING