9609-046 (SFD)LICENSED CONTRACTOR DECLARATION
I- hereby :affirm under penalty of perjury that l'am licensed under' provisions of
Chapter 9 (commencing, with Section 7000) of Division 3 of the Business:'and
cv,LU,.i °' Professionals Code, and my, License is.in.full force and effect.-:
C_ ` License #Lic. Class Exp. Date
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LJJ 6740711
Z r, Date° 4➢ 06' Signature of Contractor
Q S .
OWNER -BUILDER DECL'AR TION
W ' (� _) f
H LU I hereby affirm under,penalty�of perjury that I am exempt from the Contractor's
U)License Law for the following reason:. 1, 4 ' `•
- . 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 ($ec.*7044, Business & Professionals. Code).
( ) I, .as owner. of the property, am exclusively conir"aciing with• licensed
contractors to . construct the project., (Sec.7044,, Business &' Professionals
Code).`
<•`) (p. I am exempt under Section B&P.C. for this reason -LO
F>
N Date Signature' of; Owner
O .'�
FL Q WORKER'S COMPENSATION DECLARATION r
o< C I hereby affirm ,'under penalty of - perjury one. of • the,' following declarations;
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O O 1 have and will maintain a certificate of conseni.to self -insure for workers'
X LU LL, compensation,. as' provided for:,by Section 3700`of=the Labor Code for. -the
J. Q. performance of the work for which this permit is. issued.
I have and will maintain workers' compensation insurance as required by
Q U'Q Section 3700 of the Labor Code; for the performance of the work for which,'this
Il 1-•: permit is issued. My workers' compensation insurance carrier &•policy no' are:
Z.. Carrier . Policy No..: .
C) rA7:ls rE �rlr.� .
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Q (This section need not be completed if the permit valuation is for $100.00 or less).
J O 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 f14
workers' compensation laws of California,. and agree that ifd should become
f, Z.
subject to the Workers' compensation provisions of Section Voo of :the Labor
v Code, I shall forthAth comply with those provisions.
Date: 6 ` Applicant
Warning: Failure to secure Workers': Compensation coverage is unlawfuland
shall. subject an employer to criminal.penalties ana-di'vil fines up to $100,00.0Jh
addition to the cost of Com' damages:as'provided for in Section. 3706
of the Labor Code interest and 'attorneys 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. fr=
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
ariy-permit issued as a result -:of this applicaton agrees to, & shall, indemnify
&tthold harmless the City of La Quinta; its officers; agents and'employe'es:
',Any permit issued as a result of this application becomes. nulkand 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 ceoifV:that I have read this'application and state.that tfie,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 for inspection purposes v'
y Signature (Owner//�q t) ^_ s Date
PERMIT# CONTROL#BUILDINGPERMITLOT
y
;_7'VALU:ATION 7.2
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DATE At .4O
JOB SITE%a� �9J:� �t� 4.E0tl9l�JL
APN
,ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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KtF�GRUVNTrfY.,
USE OF PERMIT
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Cw.rom M't`F•i;TXIIQW 3,465.00 6W -
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PLAN CREC F1113 101 Q0Q43xN3J-8
' � �7C3;tY°X UC 'i•iON FRE,. ii:i -t1W-418 U $094.607
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PLAN
AR i 1N i'11i3i111331'1"701.4)6.L55-000,
ACt.'I' 11J PI;;(I�i•:M PI.AQXS Xi 's!M'1 `70.1�t9)6X 7S5_0(k)-U65.%4'
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9t! t1 '!'IN DUE �t ted
S$;3. 6.52
RECEIPT
DATE
BY
DAIE FIN ED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
— (p
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
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
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
_ CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
-777-7012
INSPECTION REQUEST LINE
777-7153
Owner J.D. DESERT DEVELOPMENT.'
Contracto SPARKS CONST
9609-046
Permit Number
- POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-015 VIA CARMEL
JOB ADDRESS
PLAN 1 SFD LOT 21 '
TYPE OF INSPECTION' DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
E MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNITIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB ^�
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
' . DO NOT POUR CONCRETE UN61L ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF lJ
BOND BEAM
O.K. TO WRAP it
GROUT ❑ 4' ❑ 8'
FRAMING :G>r
INSULATION
PRE-ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
• DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
` POOL FENCE & GATE
' SEWER EPTIC TANK �-
FINALS
ELECTRICAL S
PLUMBING
FINAL GAS TEST
HEATING- A/C '
HOUSE NUMBERS
JOB COMPLETED 77 72
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO,
1/96 TURN ON UTILITIES OR OCCUPY BUILDING