9612-020 (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.
j License # Lic. Class Exp. Date
Date ` Signature of Contractor J
' f
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.
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:
Carrier7y� �} Policy No.
J rt .1 Gi .P VIN 13710M
j�'i .
(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 Mie workers' compensation provisions of Section 3700 of the�Labo
Code, I shall forthvyith comply with those provisions,.:
Date: Applicant
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 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, nd-State laws relating to the building
construction; and hereby authorize lrepresentatives of this City to enter upon
the above-mentioned property,,for,inspection purposes.
Signature (Owner/Agent) Date l
PERMIT# CONTROL#
BUILDING PERMIT
rYF`1L1'M4423
DATE VALUATIONa4��1,�r�a.�lai LOT, c+f1 TRACT` s�
1. ' JOB SITE
ADDRESS ��fa 14 1.,A CARNIJ4111
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
',t:►. 13-OPio"
792,455 iit't, CHC LA. Qt.A rA. CSI:.
1,A i�1.INI-A CA 927-13
Uk Q1.11MrA CA 9225:3
USE OF PERMIT
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S0,8 D'FAL COMI" RUC'T'ION AND MAN CHECK
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LESS PRE -PAID FE E
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TOTAL 1'F# MIT 1 ERS A11F NOW
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RECEIPT
DATE-
BY' . '
DAT/EJFINAL
�
INSPEC
INSPECTION RECORD
bPERATION
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 Wail Insulation
Condensate Lines
Party Wail 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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines L-- v
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
' I
� oTG o
CITY OF LA QUINTA
�•a BUILDING & SAFETY DEPARTMENT
777-7012
•INSPECTION REQUEST LI
I"� LA LINENTA
G
Owner T.D.. DEVELOPMENM, ,
Contractor SPARKS CONSTRUCTION
Permit Number 9612-020 t=lnt MrE DEPT.
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-816 VIA CARMEL
PLAN 2 TERRAZA
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
- Q
PRE-GUNITE ,
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
` CONCRETE SLAB
- a (• L
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
`�hvti
- 47 ^i x Ge
' DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
j ROUGH PLUMBING
1 ROUGH GAS & GAS TEST
s HEATING & VENT -A/C
FIREPLACE
ROOF
-Z-/ Z
BOND BEAM'
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
-
INSULATION
�-
PRE-ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH L
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK /— I
FINALS
ELECTRICAL 1/
rwmon.�
FINAL GAS TEST
HEATING - A/C
U^1 ICC All IAIDCDC
JUD %lum rz I cu
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
7/96 TURN ON UTILITIES OR OCCUPY BUILDING