9907-542 (GRES)s LICENSED CONTRACTOR DECLARATION
I.hereby affirm under penalty of perjury ihat l am.licensed under piovisioni,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 ,!EExR. Date
Date -,'Signature of Contractor
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 isnot intended or offered for
sale (Sec. 7044, Business &Professionals Code). r '
( ) 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 provid'ed,foe by Section 3700 of the Labor .Code, for 'the
performance 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:
Carrier Policy No.
STA'17 FLT f}3(a t'B*N Y1> ^, 1
(This section need, no a completed if the permit Valuation Is for$1 d0.b 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 Tanner sous to beco e.subject tolhe
workers' compensation laws of California, 'and agree fth' t if I sh uld become
Subject to the workers' compensatlon..provlsrons of -Section 3700 of the Labor
Code, f-sshall forthwith comply with those'provisions.
Date: F Applicant—'
Warning: Failure. to secure'Workers' Compensation-cov rage is unlawful and
shall subject an employer to criminal penalties"and civil:fines up to $1.00,000, 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 Buildingand 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 havei 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 representative's of. this City to, enter upon
the above- mentioned;pr'opertyi' r inspection purpose
, I.
Signature (Owner/Agent) 1 Date r'
BUILDING PERMIT PERMIT# 4
DATE + VALUATION_ TRACT
LOT. "07-542
r(
JOB SITEI (
"
JAPN
ADDRESS
79-035 VIA CwURTd
OWNER CONTRACTOR / DESIGNER / ENGINEER
T.D. DESERT DEV�H.OPMEN .. ' . SPAW Cs:?MMUZ, r oN
P.O. BOX 171:6: , hu -105 5 RANCHO LA Q1:I,U't`A DR,
LA QIANTk C 92253 L.AQjJRAT .ik CA 91.253++9
96
USE OF PERMIT -
9K ek,
ATIPLEMENT.Ai. TO PFRAti�ti'.i' 09809 257,,-4 'p INC1' CCU CA.R,T ; ARAQF "T(5
fkS8MENCE. L1Ni. ER CON•9Tih i3CT11ON
GPkRAOfdCARPO1k
EsnnvrcD i-`11'R't' 0'4+ ("ON""gi-KrI TON
2;,980.80
PERMIT SEE SUMNLA.RY
PLAN .'S35.10`
CON3i'ltUCTIONF4;I 1Qi-Qlitb-/4! (3 4i5�#.e10
S`� ft<3IdC; IC1T10I� . - tN SIO_' 1()1, t3Ek� �b 1-UtK9 1,.5+0
][NFF,.t1h1`tZUC T'(.I E 22.5 d) 443-342
_365-27
ART IN PUBLIrPLXCU'S-:0,31 '1 IL -000 -255 -WO
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.ESS PRE-PA,C,):lTES
$0.00
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
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
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:
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City of La Quantd
Developers Project Approval Form
Prior. to the issuance of Building Permits for the project listed below, the folloriing Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
meter approval. Contact applicant for resolution of conditions preventing or caelaying approval.
Project: Golf. Cart Garage addition (plans in Bldg_ .Dept.)
Rancho 'La Quinta, 79-035 Via Corta
Applicant -Contact: 'Nolan'Sparks, Sparks`,Construction, 771-1941
Application irculation ate: 7�
Date
:
Commmuty Development Department
Christirle Di Iorio, Planning Manager Date
Public Works- Department
Steve Speer, Senior Engineer Date
Building and Safety Department
Mark Harold, Building and Safety Department Manager Dat.,-
Health
atrHealth Department
Date
Fire Department
Date
Schools Fees Paid
Date