9612-032 (SFD)LICENSED CONTRACTOR DECLARATION
U I hereby affirm under penalty of perjury that I am licensed under provisions of
Ct-apter 9 (commencing with Section 7000) of Division 3 of the Business and
CV W Professionals Code, and my License is in full force and effect.
O Z) M License # Lic. Class Exp. Date
I-- O r>� bi��� 11 ,
ZO Date Signature of Contractor
U 0).OWNER-BUILDER�DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ co 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
.,RIP (Ser.. 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
LO
N Date Signature of Owner
ON
G7
Q WORKER'S COMPENSATION DECLARATION
C:) CC I hereby affirm under penalty of perjury one of the following declarations:
Lo H Q () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= 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
Q Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
a Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
Cb D 3TATE" FUND B7105!40
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
3 subject to the workers' compensation'pr`ov4slons of Section 3700�"of the Labor
Code,fI shall forthwith comply with thosetpr vision9
Date:-'-,i°� ` r Applicant X t!!
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
�^Vip & 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 •authonze„representatives of this City to enter,upon
the above-mentioned properi0o inspectionrpurposc
Signature (Owner/Agehi) Date 1� ' �'✓�
PERMIT # CONTROL #
BUILDING PERMIT
4 1
DATE VALUATION Y ►4 9 ,441 LOT. 70 TRACT l�V11
JOB ADDRESS �%lfL 9.5 vilk CARMEL
APN 649,210-004
OWNER
CONTRACTOR/DESIGNER/ENGINEER
). IJI.181111U U1jL'Fa:I.i).PMENT VP
SWARKS CONNI'4MCVION
P.0, M X 'I W
19295.1'.ANCHO LA. Q0JN 1'A DPL U
CA. QjANI'A (.*A 07X;3
1t,A 01,11N t'11.(!A�'a 92'<53
y
1�!!_ib ti.liftii-S l lidlE I: t.la INC.
USE OF PERMIT
SiNGY1 #
KIVOI VVIiS Ri.1e4.1^;t 11 AN ART IN K11,ILK' VLA.(T'S CR -KAT (,W
T1�f1`t�
SU,574110t AOR K -Aft -K WI1110Jh3.kt!li._I3T0i\L1k
ONSTRIA710N 3'4650 SF
IN)RCIfWl&i IQ :33S_00 s1:
Ii 3 AR Af;'1:UCA1tk+± did T 60*00 ,S
1,Wf1h1,%T ED COS! OF CX)N3TRtfCTX0,N,
°1N:.�N�� 1 :i�';r:.Ya: 5�14�9t1►�4,tt\'
PLAN CH I k F14,, S1,or,� 9.5
('1014'.fi1'itILY-PlIO J ["FF 51,;40 00
iVf=XI.tAC ICAL YE E 1011-1}W--421000 SMIN)
PL..1"I'Kti'A4 1+h &211.44
P I A401 N t 114X S.206.00
;r1°c NCv W 1 KYN R;1; - 371?13117 101-ofX0040 V-5 0
GRAD3`i+i0 -71W5 101-000-42.3`000 `1s.f14f
t�r� 1�.�,���xt.r���r4�fz1; �'lli a7�-utx)-�1�id-�=11 Statk3ti.fit:F
PRE' .:fSt PLA17 101-000-441-345 $25.00
_
AR I° TN Pr'0 ft' Pl.A CPS . RESU'P 7431 000.-> S5-4, i1 $465 Y4
Sii,r 1tJ k 4Ff3f.1{` f>t.rl(! t w TLi° if1 11}1�U(i1>-2i.� Q40 4165,71
LESS P.RE,1D.A.11)171'SS
-S-U5.74 ..
'(0TA),1t'f+;�tY19 ff 14104 011p, NOW
�i3.�9�.5�
RECEIPT
DATE
BY'
D' FIN D
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING APPROVALS
J
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 Wall Firewall
Exterior Lath E
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection _C
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:
0
,,,PF LA QUINTA
INSPECTION ST LINE
777-7153 c 10 1996
Owner
T.D. DESERT DEVEL KENT
Contractor SPARKS CONSTRUFRAWE DEPT.
Permit Number 9612-032
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE. SPACES
JOB ADDRESS • _ 78-895 PIA CARMEL
PLAN 1 PALACIO ,
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
C
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE .
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB.
l j
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
.@
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 / r
POOL PRE PLASTER
FENCE & GATE
AEWEIR SEPTIC TANK / 7 Cf 7 f�
FI VALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED C-
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
7/96 TURN ON UTILITIES OR OCCUPY BUILDING