9612-025 (SFD)LICENSED CONTRACTOR DECLARATION
tl hereby affirm under penalty of perjury that I am'licensed under provisions of
Chaoter• 9 (commencing with Section -7000) of Division 3 of the Business and
-r-'Proteesionals Code, and my License is in full force and effect. r
License # ' : Lic. Class Exp Date
Dated : �h ' °� •Signature'of Contractor ,
OWNER -BUILDER DECLARATION.,, ;
I hereby affirm under penalty of perjury that I am exempt from`the Contractor's
License Law for the followirig 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` i5e6P6rty . am. exclusimy contracting with, licensed
contractors .to construct the project (Sec. ,7044, Business, & Professionals
Code). /
O I am exempt under Section , B&P.C. forthis reason
Date Signature of Owner
t WORKER'S COMPENSATION DECLARATION
I hereby affirm_ under penalty. of, perjury one of. the following declarations:
(,) I have and will maintain a certificate ofconsent 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.
Se( ) I have and will maintain workers' compensation insurance,,as required by
ction 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 7 • •- Policy -No. • 1.. .
Vtwyt3 2;3i ltir3�,3i.t•.
(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 notemploy any person in any manner so as.to.• becor a ubject to the
workers' compensation laws of California, and agree that,if I should become,
subject to the, workers' compensation provisron� of Section 37001of the Labor
Code, I shall`forth'6th comply with those provisions.
Date: ir' ” /IT Applicant—
Warning:
pplicant Warning: Failure to secure Workers' 'Compensation coverage isunlawful and
shall subject an employer to criminal penalties and civ I fines up.to $100 000 in�
addition to the cost of compensation, damages as provided for In Section 3706 .
of the -Labor Code, interest and attorney's'fees. .
IMPORTANT Application; is hereby made to the Director of Building and Safety
for a permit subject to the conditions' and restrictions set forth 'on '. his
application.
1. Each person upon whose behalf this application is made &each person at
whose request.and for whose'benefit work is performed under orpursuant•to
any permit issued, as a result of this appliCaton agrees to, &.shall;' indemnify
& hold harmless'the City of, La Quinta, its officers; agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of -such
permit, or cessation of work for' 180 days will subject permit to cancellation:
I certify that I have read this application and state that the above information is
correct. 1, agree to comply with, all City, and State: laws relating to the buildirig
construction, and hereby authorize reprelsentatives of this City to enter upon
the above-mentioned property.,for insection purpos s: / f'
Signature (Owner/Agent)', / 1 Date'`i.i:_Z.
"PERMIT# CONTROL#
T BUILDING PERMIT - 44.1;.
i,i ia$ LOT' TRACT_
DATE VALUATION• .,d ( AFi,�.h4
•
ADDRESS rli% :5 Vii t:d.�8'1:i'��EL . JOB
APN,
4� 10.61
OWNER
CONTRACTOR/DESIGNER/ENGINEER
3,l� Sof=f�4k`T'".ttti.t�ltfe�iwrl9 fa;f'Af21���+t;Ufi1"ii�.1�101�t.
P. . ;3 iA' ,1711� i
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Q N . CA 9225
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(OW)17119!11 CMU', 2996•
1
USE OF1PERMIT
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RECEIPT
JDATE
BY./-
D E FINALES,
6
INSPE O
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs -
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
SteelCombustion
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 P[bg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste LinesHeater
-
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)
r .
�oT 65— '
. a 0
_ s CITY OF LA QUINTA
4r
OF
° BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTI07�Ti�-gfS IMINTA
T.D. DEVELOPMEN,'F(' 1 0 1996
Owner
Contractor SPARKS CONSTRUCTION
Permit Number
9612-025, FINANCUr—pt
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-856 VIA CARMEL
PLAN 2 TERRAZA
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
-MAIN GROUND SYSTEM
GROUND PLUMBING
t PRE-GUNITE .
DO NOT POUR CONC ET& UN-(IAL B VE AS BEEN m
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
IT o- C
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
0. K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION Z
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL -PRE PLASTER
ROOL,FENCE &GATE
SEWER _SEPTIC TANK .' ' C,
FINALS
ELECTRICAL /
PLUMBING -
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS '
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
�,�� TURN ON UTILITIES OR OCCUPY BUILDING