9609-043 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CV. W 4'�Professionals Code, and my License is in full force and effect.
O 2h License # Lic. Class Exp. Date
r- d'T` c�744374I3
,�, .•
ZO r" Date f Signature of Contractor--"'
U °) OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ Il 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 Cade).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C0 () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
O�
CL Q WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Htr
O () 1 have and will maintain a certificate of consent to self -insure for workers'
W 4: 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.
n Q L) ( ) I have and will maintain workers' compensation insurance, as required by
J U Q Section 3700 of the Labor Code, for the performance of the work for which this
L LO
.Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
00 2TrA113.Ff NI') 13710959.1
Q
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,l'66uld become
subject to the workers' compensation provisions of,Section 3700 of the Labor
3 Code, I shall'forthwifh comply with those provisions.
Date: r� �� Applicant
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
& 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 for inspection purposes~ r<
Signature (Owner/A'genty " Date
CONTROL#
BUILDING PERMIT PERMIT 960-043
40.69
DATE VALUATION S113,14-1.44) LOT I,( -Tr 18. TQ6952.1
JOB SITE 714"1645 11S21fA C°A�CMEI.
APN tiri9 � ti3-(i35
ADDRESS
OWNER
CONTRACOR/DESIGNER /ENGINEER
F (;[ (' •f .3/ .{.iiti G,:i\,i' l�i: i4�, 1P-jl`{Yiti t L.,��
".10NN '
APpYUK4iV:1jUC
Ro. BOX 3 716
79295 tt.ANCI 10 LA QI.1tNTA D'R_
1.,A (iJ1N 1't1 ?'A �i7:5'3
r,A.C�tlUNI'A'-A 9225
771-1941
019)771-1041 CDT.# 2996
A1?bti�;i,, Y�'t�iT 7t,j„(. 1 GLIA
USE OF PERMITij1:
tilNt,,iLP: 1<,eWILY f. WL-'1,1,iN4.,
236*r2 01R.TC11PN M. .
PLAN z t'At ALIO TRAC r 27!i12- t
1. 19tA. VC • ERRI tilsl t?C I' AN e1,W,1' IN PUBLIC PLACES' CCtI°3w (1.M
S5_}'x.401 Ptilt A utt.i3MW W111 i f 0N1MOMIT DEM, C PAMF'sAi'C
CUSTOM (:t` N,1X 1R(tr'r10N 3.8'122.00 SF
Poo ttll- K1110 ISOM S'
aARAC1 ycAfif oR.'1' r0i,53.00 SJ
/u.ST sM.AA. Rl) .OMI OF \„O7'1:STRA)C4 tON '
3.1.7,18#.40
1?ER1►xl T ME 4'(T'N1MARY
PLAN �., It, CV. IF EE 101-00 0439-318 31,:35:90
CON:>"r.Rt C'TION FEE 101.006-418WCtt}ii $133.50
Fil&C;1CAN•IC.ALf-EF 101-000-4. 2-000 51.37.00
sJU.:.Fk,'r �1CA1. I" ER, 161-(F(3(}M�IN)-000 $"�2 r.t19
LLM*4fI I%FEE. I!31�J0-4.1A.r}G�t 5A1 6,00
S'fC9N�G,iMMION,.FEF -RESID i0I-1309-211i,i}0 311.32
GRAD WO IFF6 1t11 d30t3-42`{-t?f)0 S20.o0
1NFFtAA 17ZUC°rURr6 r-`3sFl 225-0004A1J 1342 scow bo
fl".Ci3 l PLAN AW -OW -4-41-345
ART IN PUBLIC PLACF3S; - R S'X ?01 -M -2545-M $53295
APL`s 1N PURLIC PLACk:S - i2&SM 701.000.255.000 4532.95
1, FS8 PRE -:PAID FEES
4532.95
1'O`GAL PRitMIT FEES DUE NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Root 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 Wali 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
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
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:
V
a
_ CITY OF LA QUINTA
OF - `'� BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner T.D. DESERT DEVELOPMENT
Contractor SPARKS CONST
9609-043
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-045 VIA CARMEL
PLAN 2 SFD LOT 18
TYPE OF INSPECTION DATE INSP.
1 FOUNDATION & SETBACK
FOOTING STEEL !/
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
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 L r
BOND BEAM
O.K. TO WRAP
GROUT' ❑ 4' ❑ 8'
FRAMING G
INSULATION -
PRE -ROOT=
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR .
EXTERIOR LATH c - (�
POOL PRE PLASTER
ENCE & GATE
/SEWEPJSEPTIC TANK /
FINALS
ELECTRICAL S �f
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING