9710-108 (RER)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
574074 1 l ?!31!99
/ate 1-1 it - Signature of Contractor -+'-_`1
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 maintaina 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:
Cartier Policy No.
STATE '.FUND 137109597
(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
w 'kers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Fode,1 shall fort3with comply.with those proVisiQtins�
Date:t "-1 t fn -)Applicant
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 Quints, 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 inspection purposes. f + rac
Signature (Owner/Agent), Date {�
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT 9710-1114 TRACT .6152
1 4 /e 1 $2,000.00
d_2
JOB SITE + '
APN
ADDRESS
78-M RIO SECO
OWNER
CONTRACTOR / DESIGNER / ENGINEER
T.D. DESERT DEVELOPMENT
SPARKS CONSTRIJC- LION
,9295 RANCHO LA. Q'UTWrA 'DR.
7929.5 RANCHO LA QVINTA DR..
LA QUINTA CA. 92253
LA t UINTA CA. 92253
(7h0)`�71.19�1:1 C80 29 6
'
USE OF PERMIT
TEMPORARY T OtLET WrM TITLE 24 REQUIREMENTS LOCATED W
CIARAC.rL 01"" MODEL. THIS .18 A TEMPORARY SERVICE AND W01, BE
RESTC)RED `ro ORiorNAL GARAGE FINISH
VALUXfI.ON i 2,040.00 LS
EST IMATED COST OF CONSTRUCTION
2,04ft1.tio
:'PER AILT FEE SUMMARY
PLAN CHECK .FEE 101-000-439-314 $29.25
CONSPRUCl.'IONFEE 101-000-418-000 $45.00
ELECTRICAL FEE 101-000420-000 $15.00
PLUMAINti FEE 101-000-419.000 $33.00
STRONG Iv1OTIONFEE-RES'ID 101.000-241-000
SUB -TOTAL CONSTRUCT I7UN ANIS PLAN CHECK
$122.75
LESS NU-PAIDPEES,
Ph* I
$0.00
TOTAL P/ER%11T FEES DUE NOi't'
$122.75.
OCT 2 4 1997
ECEIPTq i..L. , ���
�.
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 kines
Neater 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
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
' Utility Notice (Perm)
COMMENTS: