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9612-036 (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 f+.©' � .Signature of Contractor �. I 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.- enalty, 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 S, ctlon 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. 5S 1" l E, 1 IJ 1371©3 Iii; (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,.,provsli onsi ofS ^eiction 3700 -of the Labor Code; I shall, fortsiwifk comply with th use provisions. Dater 7 "X 1' Applicant— Warning: pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $1,00,000, 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 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 ffoorinspection purposes Signature (Owned'A ent) I I Date (`" ' , K C-. BUILDINGPERMIT PERMIT# CONTROL# �=1 ,Ljl 4409DATE VALUATIONii3�2�� i1(1 LOT , TRACT JOB SITE} ADDRESS J "I'�-8.�t $1' Qt�i'�4[��1<J'�'�:�1..'1.i APN 649-2_t4-004 OWNERI CONTRACTORDESIGNERENGINEER `.1'.1,3 7../i. nll:�w i'. i.J(7 v�ij��:.:7.r�"S e.l d'f'. i.•'� �/ `/ • 4 �p all9 t'i.l`�Ci .� i.,�•e.34.3 R•riW��RiiV i°: K i A6 792,95 RANCHO LA QU1,N i,t1 Dk. IA (.,A)IN i A (2A 92251 I..A QUINTA. a CA 92153 i (4619-11771-11941 ctil..# 205 - Pq,. iVtiTi,-t;aZANTAIL,1 C. USE OF PERMIT . KING A. P M1Llr 0Wf,�LWN(_; 1010'tuti@fit OR, 3,10—. 74 PETI, AL3f.2S?;I~, MIxNT WfTt'-(. (_%.)hVVI.0N11`Y 1yRYF OPMEI+i).' CUSTOM CON S`1'F,UC"1.°(aN 3.x145.0() SF P0.1t0VIPATIO, 1215.00 Sr, ti7�.l�l�OL?ft�Aitt�1Z1' nt}tt.ti() 4F S'..�.�bia@.iYRAIEED COST Or' S.L.rNST,i.YPi.lMON 236.299.90 PLAN CW,.0 i FhE 141-(H1fl-4:39 :?t1.8 �f.,4t��.95 CC) WSTRU(CTION ;fWe $1,29i.00 AtIMI.A1d1C."A1., :PE 1014VO-421-010. $145.50 Ir�l:.c�JC:.'T9(0A1, ful 141-00fG €2040) $2,13A PLUMING FSK 101-f)O0419aO 32K00 STO:NG Mrs, PIN RE o RffSt!) 101.-0 0-24 t-000 S�:63 t:RADfN1C ITI, $NA) INt•.(GV*;T R_U0.r lJ" M. 225.000413-342 56,0(10.06 'PJZ1 ..1S1 PLAN 101.OW-441-349 ART fK 1 VIRLIC, PLACE,$ - Rr811' '70 U( 0.255-1)tj{! Y+B+S5,74 MT NPLIB tC'MAC S .4891.L 701'.1100-255-000 -V65.74 . .t WW'IY?` A 1, C0N;.1 RAJCTJ0.N AND PIAN OJECK 59,462.26 LESS PI.1.F-1WIDI FEES 4465.7%: . T0TA1.,vrRmrr mus ouri, Now. $8,9%.n RECEIPT DATE BYE D E FINALED INSPEC INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings / G, 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 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) COMMENTS: - _ CITY OF LA QUINTA OF a BUILDING & SAFETY DEPARTMENT OF LA QUINTA INSPECTION REQUEST LINE "" sIIE C 1 0 1996 Owner T.D.. DESERT DEVELOPMENT Contractor SPARKS CONSTRLFdYWE DEPT. Permit Number 9612-036 ` POST ON JOB IN CONSPICUOUS PLACE ' INSPECTOR MUST SIGN ALL APPLICABLE'SPACES ' 78-831 VIA CARMEL ' JOB ADDRESS PLAN 1 PALACIO TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING ') 9,C PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS S BEEN SIGNED CONCRETE SLAB 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 l INSULATION PRE-ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH �l POOL PRE PLASTER PgaLENCE & GATE EWE SEPTIC TANK 1- t FINALS ELECTRICAL 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