9612-034 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
f– Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
(V co Professionals Code, and my License is in full force and effect.
O D Ch License # Lic. Class Exp. Date
LU 40-4 a
CE
Z Date Signature of Contractor ,r
O!
T OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
J
~ License Law for the following reason:
Z_ ( ) 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).
c'') () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
a Q WORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm under penalty of perjury one of the following declarations:
LO O () 1 have and will maintain a certificate of consent to self insure for workers'
X W u- compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
co QU ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
qt Z Carrier Policy No.
Cb �i',I.f f1;�1 i3 {()!�4:,t_;
J (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 provisions of,'Section 3700, of the Labor
Code, I shall forttE�i comply with those -provisions.
Date:y,�' 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 $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, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property or inspection purposes.
Signature (Owner/Agent) ���--`"""� Date ,
PERMIT # CONTROL #
BUILDING PERMIT
9612-0344 �
DATE VALUATION 31.3, 01.40 LOT S TRACT Ott
ADDRESS 74-86 } VtACAM114,L JOB SITE
TAPINX149-210-004
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SPARKwC_C)t'S4".Ci:[l`C"I'�.t)°�'
PA), BOX 1716
79295 YtANCeHU i,.A Qf.JiNTA DR;
1A Q1ANTA ('A I)D%3
LA OVIIN"f A (A 131253
USE OF PERMIT
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PLAN 2
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PDLVC-111SDs PLAN 1:01,f)C)C)441u345 S25A0
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11RTCYfAi.t",t'�)V�"'DRUC11ION,ANO PIANC HIR- :'iti
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T4 AI, P'CIRMIT Da ED� S 1)VENOW
$9,1741111
RECEIPT
DATE
BY
D FI YL, G�
o� ( ?
INSPEC��/�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs — a
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 I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines _ L+ HL.
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 j
Utility Notice (Perm)
COMMENTS:
,
t � ° > Y '` ,.' s•' ,.tti R.f y'y �` �3 •N t9 �-�'t.�.y� �i�-� T' �r � -
T ,+ BUILDIN(
4D DESE
j + a' Contractor,' SPARKS°G
Number
• � POST 0[��J08`IN
INSPECTOR MUSMSIC
:000S'P,L/i
.. • _ , - - ..
7 .. ... � -
���'����.�•�7.&863�VIA'�CARME��'+'a'�=f. � ��:
Jo ADDRESS
2 PLAN2PALACIO
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'_; "; ,TYPE OF• INSPECTION
DATE , INSP.J��
" -
��SbLld /
FOUNDATION & SETBACK
-
FOOTINGSTEEL
_
MAIN GROUND SYSTEM
;
G UND PLU B G
PRE-GUNITE �.:
DO.NOT.POUR CONCRETE UNTIL ALL ABOVE HAS BEEN- IGNED
''WNCRETE'SLAB" �j '« —
JOISTS:& GIRDERS",es
`Jy'4ELECTRICAUGROUND WORK
"-DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
.ROUGH ELECTRIC - -
sROUGH; PLUMBING
,ROUGH GAS & GAS TEST - 2
HEATING & VENT- A/C
` LACE.'4
FlREPz..
' BOND BEAM
O.K. TO WRAP'
GROUT ,0 4' '0 8'
FRAMING C
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN 'SIGNED
DRYWALL'INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL ENCE & GATE
(SEWEO SEPTIC TANK
FINALS
ELECTRICAL `S -
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED 17
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
��oa TURN ON UTILITIES OR OCCUPY BUILDING
-