9612-037 (SFD)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
Date! ��'� `d�' Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that -1 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).
( ) 1, 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 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:
Carrier Policy No.
301WIT-1 FUND 137105594
(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 Isshould become
subject.to the workers' compensation provisions of� Sections3700 of the Labor
Code,'I shall forthwith comply with'those provisions.
Date: Applicant
Warning: Failure to secure Wor4s;Compensation coverage is unlawful and
.shall subject an employer to criminal penalties and civil fines up to $100,000, iri
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 hisA,
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 indemnity
& hold harmless the City of La Quinta, its officers, agents and a ployees.
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 stateetha 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., �''^� .
Signature (Owner/A e t) �' t {` t Date
I
BUILDING PERMIT PERMIT# CONTROL#
96 1.2-0:17 44
DATE VALUATION Sw1i,3,1,LOT 75 TRACT n49' fo8
JOB SITE 7VV81:7 i�IA �.Ej1R AIY1 L
ADDRESS
APN 649-210-004
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T.D. Li: ul;=t'.i' nf,.V91,0.PN1fl1iN'1' U
S11,AR, XS 41t itTs'I't,UCT1.0N,
.;;..W3,y ! 7:10295
RANCHO LA QUINTA Ilz.
1.4 QUINT 1, CA 92253
LA Cj[. INTA CA 92251
t
IM
FSKAR, -CCR NDEL WC.
USE OF PERMIT
SINGLE PAM I Y DWELLING
236724:l1XFC.f4hX OR.
PLAN 2 PALA.1030
D'liR.IVz V 1:`a`3 R1*1.VX;T A14 ,AW1 Ta'd PUBLIC 11,A.0 93 C>d.F: XT CSP
$53.2,93 VVI . A0RF,F'a1,*-3NT WITH C0M1MtJK't'Y d')F.W-t.0PNtl;'2+ T
CUSTOM CONSTRUC`CIOW 3,812,M �;E
o F
/l''L' �[is�(i�ls.t
AX) 8F
PLAN C fWCK FEW 101-0110-439-318 $I, i 35.3( t
N4,024r' NK'AL_EU` IC1.-1100-42I.•Wf)
i�t,.fie,�'I`t<3.s�`Ai.t�I!'ti' Itll=tit7i�-�i2�-£1iiG - $w2`7.tt5�
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_
G(CA1.111t4ca rIT 101-WO.423-000 wt�.(at►
PRL -;C S1'VPI.AN
ART fN'P1:fftl rf'. P4,t!!,PS 55.12,95
A.'R'T .IN PT.TK tC PL AC'II S - M:MZ: 701-060-25.i-000
17r ISA �?., COi:C€�LIt<'IUN A?`dD PLANt~'k1C1
`'?,703,16
"I'MM, P1 1101I '-i+'EF.S .0fic NOW
; 9,171i,t
lj�l.1nti(
RECEIPT
DATE '
BY
DA I LE
IINSPECT
INSPECTION RECORD
" OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _2/
Underground Ducts
Forms & Footings _ 2
Ducts
Slab Grade Lf
Return Air
Steel - 2 ' _ all
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
Utility Notice (Perm)
0.
C
j
s _ CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
INSPECTION1J1NTA
777-715nn3���� , jjl
Owner T.D. DESERT DEVEL` 6PN�'M996
Contractor SPARKS CONSTMM..�ft��
,, _ 2F.
Permit Number 9612-037
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-815 VIA CARMEL -~
PLAN 2 PALACIO
I
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
CONCRETE SLAB
it'-
f'JOISTS
JOISTS& GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED_
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATHG-
POOL PRE PLASTER
ENCE & GATE
6VER $' EPTIC TANK / -
FINALS
ELECTRICAL 'pC i1` -7
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
7/96 TURN ON UTILITIES OR OCCUPY BUILDING