9612-028 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I-_ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C\I J Professionals Code, and my License is in full force and effect.
O Z) M License # Lic. Class Exp. Date
C) r fijj� 1i P� "� Vie`
Z r bate f ; �� Signature of Contractor
rn0� a gip'
C) OWN ER -BU I LDEKDECLARATION
LU LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U)
(n 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).
Cl) () I am exempt under Section , B&P.C. for this reason
IUD
O N Date Signature of Owner
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 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.
m Q U) I have and will maintain workers' compensation insurance, as required by
O C) Q SO tion 3700 of the Labor Code, for the performance of the work for which this
D: rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
� Z Carrier 4 r�1�y, Policy No.
aoo d ST iIT.. 4' `10"N1.0 t tf39_911
Q (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-l.should become
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those P,,rOVISIO S.
Date:/1 ' ' `� 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, and State laws relating to the building b
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertyfor inspectionbpurposes.
, Z-7
Signature (Owner/Agent),,], Date Z.
BUILDING PERMIT PERMIT# CONTROL#
e l lAQU 4 415
DATE VALUATION LOT TRACT sF
JOB SITE
ADDRESS 7R-880 IA 1,�k�k-ti' Ck,
APN :649410-4004
OWNER
CONTRACTOR / DESIGNER / ENGINEER
O. 'titl.a.7�,�(i�: 1.110
b�rA,)yLR'1.,1,N+.:HO LA.,Quit♦ e,� I)R.
tP
t q 3
1 AQI_i�..lY lA 6'A 9.e�'5.3
J. .AQ(!JN A !"A 9225.1
10.0)'771, 1041 12996%
USE OF PERMIT
SfMAA,1' t~AM.11A. Mj-t,t.,ft i
11H4MIT 100'.1111IX IT AN ART .Ili! P 10,A' 1't Ac'°t S C Rft lT t W
.14.0 KJ� ,AORI.«•'�Vti�NT WI'M4'?+rlil€�+MI'iY1`�'.�`F�,t,f')l vD'NT
cpm. 1,1110 NP,
k> t i :ft?t'FI Cdfi 1 1, ,00 SE'
555 0) N
- .!STM fy fi (_.M OF C!NKMUCT.01R
IlIm 490.90
YypRRN,
1 CAMIl VIP-It"
PLAN t`f*Cia VEE
V—tai: 101-f1f3t),4)8-M
611ECIIA1+fAUAL ME, , 101-wo"I.1-000 41 ,1.50
t'i,t i lJ{i+`,� � t �t: ' hil-WO-420-000 SM,08
141t)WINO FYL 101-000-419143!.1(1 5160,00
�1i�?nicJRf��I'Y(1t� l+ T RFSIT) 101 -(x0 -2411 -QM 319,04
1{11..000.23-0{10 00
2tJi If2J1�a'i t 6J trfkf t' f. pl 225.00-443-,42 $I,Z.49.71'4
ART IN Pkff L1C 431,A.€ Q'3 n RESW 701-000-25,54M M S246,62.
ART ?N PUB IC PJ: 0 5 • k1 Sf1` 10 f 00015.5-000 _VM p^_,
:SMA -TOTAL r;f'f 1St t f K -1 10N ANT) P1 AN (71IT4'K,
LESS INH -PAID FEES
12 216 021
TOl'iI PCItn4IT Fif.KS VIf!I':N0W
4;f,ga�lw.tl3
RECEIPT
DATE
BY
DAT FIN ED
INSP)C
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —q4
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 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 Pibg. Test
Final I I
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 ConnectionEncapsulation
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)
�o7-
I
_ s CITY OF LA QUINTA
BUILDING & SAFET, MIN
777-4V P6P
INSPECTION
NE
777 7153 OEC 11 0 1996
Owner T.D. DESERT DEVELOPS
Contractor SPARKS CONSTRUCTION
Permit Number 9612-028
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-880 VIA CARMEL
A ,
PLAN 2 TERRAZA
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING - G
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN.SIGNlED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
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 �f
BOND BEAM '
O.K. TO WRAP
GROUT O 4' O 8'
FRAMING
INSULATION Z
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNS
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
ENCE & GATE
SEWERISEPTIC TANK
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
J