9612-011 (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
61071 N trill. 7
Date �' �'� Signature of ContracL� '~
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 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.
K) 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.
STAM 13111109594
(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 shoulq,�)ecome
subject to /the workers' compensation provisions of Section 3700,of the Labor
Code „I; shall forthwith comply with those provisions
Dater Yolkl/ Applicant
C. �`-
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. 4 .
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 propegrty for inspection purposes.
Signature (Owner/Agent)/� Date `2•�Y f
.9 �..
B■U .ILDING PERMI PERMIT# CONTROL#
Iv=1
•,rte,►tip 4431
DATE VALUATION N �y L ayni�y �=�.1 LOT TRACT 1) /
.'9i•�µ�ili rti7fl. �u ,f.A.3
ADDRESS 7N-7$2 VIA i,rAi+:ii EU, 'OB SITE
APN 649.210-004
OWNER
CONTRACTOR / DESIGNER / ENGINEER
F#t'1'i,'f:IV, f f. 1.I'M�,H1,:t,T'
ri'�1i:�:M� tJR:�"C1�1TC
P.1..1.1 C)N 1716
/929-5 (tEVvt,.HO LA CG1.. M'& DR.
1.A. t �1Jit� (ti CA 91251
LA OWNTA CA 422;53
461W.714941 (w"'MN 2996
USE OF PERMIT
:�iN�.;i.l: 1+t411i11,1' 1"�Wt•?i.t.Ihit.f
3�L32NI('I' i�lif?'3 ItFtrJXCf AN ART IN PUBLIC I'LACEa3 CRiF;11JI`,t' OF
$213.4:5 PEN AORCIZMfNT Willi t�MAti1M1IhI"h`�l"i114'sl,EahM1sN'i
C (:T'.r0M Ct.' NS" 17tih UION 212:31.00 S1
f'U].tC tUlyrl'i'(a 00.09 Sr
C3A1�Aaii.J4aK1(:�it'f 4860) IS1
'�.��':'��'�'I�">;'k;� CY•i�';4'�It� CC3l�:�: R�i�'Z".CC?�r
.tR.`.•,:�k1.;�R1
1'14:RMI T F 1+ R SGININI AR
PIAN C-MCK ED:` 1011 -OW -431-:3121 $?']4.54
t;ONS'jRUr TION l:`f~,1? 110-()OO.4184M 394t?,SA
I it:,HAN(CAI. F'1 s 101-000- 421-M
1111RC RIC.`AL i s 10l-000-420-60011 $167.81
F!LUNIBIM.1 F07 101.-00041,9-011V $142.0)
�3 jc�j`rfl m#O'C1t N F1':1Y - R S1U 101 -••000 -2 1 -UW $m%
ORrlDI N(s FEE $20.00
th`l�liA�; `f�iJt"tYlftEs l -#?t; 225-M-iWX342 $4.124.71
ART IN 140131,1C; MACF3 - tt&SIC 701 _OW2:554*0 $213.93
Afr.r'(N T)VALTt; PLAIMS - R 51+,-701-00-255-0) 3'13.11
St 121-'1 1' 1.. Ct fNS 1'lirJ(:T((;r, AND PL N CHECK
$h,S(10.t7
LESS PRE-TAID 1.1?ES
TOTAL PERMIT FURSDUCNOW
RECEIPT
DATE
BY
D FIN A ED
INSPECT
INSPECTION RECORD
OPLRATION
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 Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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:
o 7-5'2
s
a
_ s CITY OF LA QUINTA
a ° BUILDING & SAFETY DEPARTMENT .
777-7012 '
INSPECTION REQUEST LINE
(lW LA QUINTA
Owner
T.D. DEVELOPMENT
Contractor SPARKS CONSTWVtii6#96
Permit Number
9612-01 hNANICR n1-p!r
POST ON JOB IN CONSPICUOUSPtACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
78-742 VIA CARMEL
JOB ADDRESS
PLAN 1 TERRAZA
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
75
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
G
BOND BEAM
O.K. TO WRAP
Rae
GROUT ❑ 4' ❑ 8'
FRAMING
_
INSULATION
' =
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR -
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK 1-7077
FINALS
ELECTRICAL G /
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