9612-022 (SFD)LICENSED CONTRACTOR DECLARATION
(n 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
CV W Professionals Code, and my License is in full force and effect.
O Z) M License # Lic. Class Exp. Date
W r, •6—to-1 f 0ii51i
Z r� Date�� Signature of Contractor -
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CD �' °� OWNER -BUILDER DECLARATION
J U
W W I hereby affirm under penaltyof perjury that I am' exempt from the Contractor's
CL
W 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 property, am.exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C) () I am exempt under Section , B&P.C. for this reason
LO
CV Date Signature' of Owner
O CV
CL Q WORKER'S COMPENSATION DECLARATION
iO Q Cr I hereby affirm under penalty of perjury one of the following declarations:
f F -;O () 1 have andwill 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
O J Q Performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
Z permit,is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
w O s GATE- mum
J
(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 becme
subject to the Workers' compensation provisions of Sect% 3700 of the_Labor
Code, I shall forthwith comply with those •piovis ons`
Date:.b / j rc� & Applicant—
Warning:
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 Pursuanf 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 [have read this application and state that the above information is
• correct. I agree to comply with all City, and State ws relating to the building
construction, and hereby authorize) representatives pf this City to enter upon
the above-mentioned propeity for inspection-pdrpos s.
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Signature (Owner/Agent
BUILDING A PERMIT PERMIT# CONTROL#
1Li,111111I 96112-022 4421
DATE VALUATION ftyl���d1��. tl LOT TRACT 29343
JOB SITE ADDRESS fab -'832 VILAC.c�E11t UL
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T.D. J. �:Ei�:':�1 :'P?3,f't.}a?t'2� P:"!' L,r� t:
�i.'Ait..tia!�'?�ivs'7?2;JC01'1t):;�
P.G. WX i 710,
192195 .idANCRO .0 QWNTA Dk..
lA QUINi'A CA 92253
t,1 Q0INTA. CA 92253
'619)711-119 41 C1�L 2996
USE OF PERMIT
8INC3t,t3 i�AM.11,1"OW1':J LINICS
0 -WANT k'IMS f20 Ll t,`.1' AN •ART fid P I LIC 1'1.tJ CICS (30011'OF
$226.02 P R•A.GRt11s's">y'M" KI` wrr'F. c,,r_*wuN1'I'Y I31;VI I,E?PIv1.t Ni
CUSTO TN'1 C rh}C�" 1011: i'IC+N 2,285,00 SF .
s i)RCHIPA'i'EU 1 f5.tx) 9;
0 ARAtatl�fCAIWORY 555.00 3111
ES' tilA.'T'CI:U CMIr O.'? CONS TRUS:'I'IaN
190,409,010
1,`l.AN CkIF(.~K FRE 11'1'1-V14A39-318
C'ON'S `RUCTI!(lNFM 1014}(lt}-4J0.0 0
it"14AN1L, 101-M-4211 $111.513
OX-A"rRICAL F 01-tj-420-tiN $171.68
PL15WI NG I:•ssr; 1014t* -4194)00 $160.00
8`.iVNo A40T10 N Ft"I? - .'RVS! ll 1101.0110••241-001[l $19.04
GRADING M 10t-000-123-000 $2fi.flf3
I ,`. r-RAS'i'ItUC'1`URkiFEE' 225-000--443.3412 $4.249.79
ARI' I.N' PUBL.IC ..PLACE.8 - RESTV 701-000-255-000
ART IN P11PLIC Pi—ACTS. - rmiwfI 701 -OW -2.554)00 -$x5.02
"YPRY:► AI., CONSMU(:1'IM AND PUAN CHECK
X5,71 l .t?5
LESS RM -MID FE ES
-$226027.
:.
'9'OTA1; PEIti1 I.Ir FEES DUE, O
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u
RECEIPT
DATE
BY
DATE FINALEP
INSPEC
-A
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 PI . Test
Final I I
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
Final
LM14 Notice (Perm)
s _ s CITY OF LA QUINTA
E . s a ° BUILDING & SAFETY DEPARTMENT
L 777-7012
I INSPECTION REQUEST LINE + x
7Z7tTV30F, LA QUINTA
Owner
T.D.. DEVELOPMENT
UL
Contractor. SPARKS CONSTRUCTION r
Permit Number 9612-022 FINANCE DEPT
POST ON JOB IN -CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE'SPACES
JOB ADDRESS 78-8`32 VIA CARMEL
PLAN -2 TERRAZA -
f ..
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 SIGNED
i. CONCRETE SLAB t ,1 At s
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
#' ROUGH ELECTRIC
ROUGH PLUMBING '
ROUGH GAS & GAS TEST 7 22- -
HEATING & VENT - A/C r
FIREPLACE +
ROOF
BOND BEAM `
O.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING 7 •i LG i
INSULATION'.
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED -
DRYWALL INTERIOR
EXTERIOR LATH -7-.._ i y
POOL PRE -PLASTER
FENCE &GATE
�, l
SEWER SEPTIC TANK
r
FINALS
ELECTRICAL ? r
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED — -
TEMP POWER '
t
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
7/96 TURN ON UTILITIES OR OCCUPY BUILDING