9807-134 (SFD)LICENSED;.CONTRACTOR DECLARATION
I hereby affirm under, penalty.of perjury;that I am1lcensed'under provisions 'of
Chapter 9 (commencti
cing with Seon 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
p X10 ;t 13 713
.-`` �� a
Date4A ,.�T Signature of Contractor
t OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) "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,,'.Codefor the
performance of the work for which this permit is'issued.
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.
(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 than-4hould become
subject to the workers' compensation-provi Ions of Section 3700 of the Labor
Code,. shall fofthwith comply with thoseproysions%
;?Date: (2 Applicant ))
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subjecit an employer to criminal penalties and civil fines up to $100,000, iri
addition fo the cost of compensation, damages as provided for in Section 3706:...
of the Labor Code, interest and attorney's fees.
IMPORTANT. Application is hereby made to the Director of Building and Safety .
for a permit subject to the conditions and restrictions 'set forth on". his
application.
1. Each person upon whose behalf this application is made &,each person at
whose request and for whose benefit work is performed under or pursuant to,
any permit issued as a result of this applicaton agrees to, & shall, indemnify 4
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building.
construction, and hereby authorize representatives of this City.to enter upon
the above-mentioned property,for ins 'Ct'on purposes. j
Signature (Owner/Agent), Date��/� y
BUILDING PERMIT PERMIT#
9807-134
% ` TRACT
DATE VALUATION LOT8
SZ"1793.40 1.5 2515 4
JOB SITE 2 ��t
ADDRESS "F�-C� ai � IiiZGt44..�.! 0
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T:1). UE SER!" Ef 11.-EWPr%4T1111- "
SPARKS COMMIUC.%tO>`J
P.O. BOX 1716' 1.
732.4 RANCH0 LIt QUINTA DR.
LNQUINTA 'CA 9225�4
1,A QWNTA. CA 92' .153
(7 )77L=1.«!.l CRL -9 2996
USE OF PERMIT
00, PLANN4 '07RM[r1 IX).1s9 NOT WC.L'Wr3 K00K "WALL& 0.11 i?�4X4.
• i
t;.ii�:�;iat•� ;��3 a'I.'id:UC°i.Lwi#: _ .2,3%,i$.E3t� �r
3Q,49() SP
GzARAGE .ARIAORT "SF
tIRMN D COM OF
213,793.40
r t N� rut r ! ! -t Jf9-E13g tU49.44
Mr ;AHICAL 1:1% I,Ooo 599.50
0r•tr`lRCAL FE 4f)1=1100 ?120-000 $167-91
f'T UNIfttNC4) i?F 1.A1-U(1-i�(}(Kl1i,45
11"K s M�+3 tt N S a'F;= REEO 3
,.:C.R A01W0 FU -S
.22011 �$� 3�: ,4•.�S.AI,,
.SRT IN tIVt31.,'tF.: PLAIw%S -111W 55-
1 �1 Q%-TYYi'.f , CRECi
1 x 77 SZ?
LES.", .1�R� -P.AID EES
$01M)
t'`
No
' #, ff x ., eFa11„#'1 i 'vliws ovc Now
$7.,427.87
� (l
RECEIPT
DATE .
BY
r
DATE FINALED
INSPECTOR
A..
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
(
Ducts
Slab Grade
.—1 —
Return Air
Steel_
Combustion Air
Roof Deck
Z C
Exhaust Fans
O.K. to Wrap
Framing
F.A.U.
Compressor
41
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
Steel
POOLS - SPAS
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
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final—
Utility Notice (Perm)11--.2- ~
COMMENTS: