9611-061 (AR)LICENSED CONTRACTOR DECLARATION
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
Professionals Code, and my License is in full force and'effect.
License # Lic. Class tarp Date
(� i t(P7a1 13
T/3 1i
.
"Date Signature of Contractor t
i
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
pert rmance of the work for which this permit is issued.
( I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy. no. are:
Cartier Policy No.
137, 10 594
(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�permi s issued,
I shall not employ any person in any manner sos-to become su�•tect to the
workers' c pensation laws of California,+and agree thafll .1.111d become
subject to Oe workers' compensation,; provisions of Section 113700,• of the Labor
ode, k2h II AoTwith comply with those provision f )f
Date: 1 4 Applicant f �` 1�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. ?'
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued 'as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and slate that the above information is
correct. I agree to comply with all, City, and State aws relating to the building
,;construction, and hereby authorize represel�tatives of this City to ente upon
the above-mentioned property for inspectionTpurposes.
ignature (Owner/Agent) Date "
BUILDING PERMIT PERMT%11-0.CONTROL#.
�
VALUATION LOT
TRACTJOB
DATE , ;�Sziyt� 1,6
SITE
ADDRESS 1119-065 V.L8 C:�e,1Etl� E L
AP0q - 2 10 — 0.35-
OWNER
CONTRACTOR /DESIGNER /ENGINEER
±
.,
SPARKS A1R?itWTiON
V,0OX 1716
79245 T2Alv'CHO LA QUINYTA .Dit
LA 00INTA CA. 92251
I.A. i fUINTA CA 972'53
(fil�?)7')'1-1"341 C.13T.;ffi tr.�1i
USE OF PERMIT
r I-N.11)l,MIA1, A1.11J1`PON
ailA) )8U .0-.'fo 0,kPI i:i: OiA-1($I 1,628.(k) 'Vr>i,iJAT101.t) ANO 270
&V. r?F W,591.0 VA1,0.w!°r1()N)t.
f21MCtM1- C11's'1'OM 11.628,00 S.F.
r.v:d2.�'#Ci�sA°CItJ �`iU,ittW sig
- �,���i�.�itik�iA��'.,�Itk'i[ (�.i{����`��9��st+►�4�k��t�
i��xi�.�ii�
H_,A2` C111Efy`iti F'tyks 1rJ3-()11(D �433r3tt� $11115
r(»N*STRtfMItON PPF: 171 fwi
NMCHANI L F11 101-000-421•4XV
1%IiC'I'RJCALV1:#; i Ell.�t)tJi3-�S�U-@�ti i � 1.3U
tN R1VVft!2£IC rr 11W V -EV 225-000-443-342 42.6 1 A%
S'j"ONOMCiTION1 1 ttl': i1) 101-i1t)f1-241�f)!1I)
Nt.)13-1111' l,ff70?48`(10JC"3 ONAND r'Isaiu('HOCK
�511t:ni1
EAG S�S, PRL -17.'111) FITS
$0.00
CITY OF LA QUINTA
, ,
DEC 19 1996
RE E o
BY
D E F ALED
INSPEC
IM
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECT Or'
R
BUILDING APPROVALS
MECHANICAL APPROVALS
Set BacksliC
Underground Ducts
Forms & Footings i
Ducts
Slab Grade
Return Air
Steep
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 Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - IM. 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 t '
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)