9907-071 (SFD)LICENSED CONTRACTOR DECLARATION
Cl) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
ti du Ai ie7
Wi i9?
6 Z � 1 Da� !/ to Signature of Contractor `
to O � v r %
J U CDECLARATION
OWNER -BUILDER _,•
W W t1_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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 Code).
( ) 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
LID
O N Date Signature of Owner
rn
d Q WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
LO - Cr O () 1 have and will maintain a certificate of consent to self insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O _ Q performance of the work for which this permit is issued.
m Q C) ( I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
li rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
ob O .1441M•ii f Ui'iii 1fi-C?f%r? i 313
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 provisions of ectign 3700 of the Labor
Code, I shall forthwith comply with those'provisions. \\
Date: "2r/7 le. -<1 Applicant -�' `J _
Warning: Failure to secure Workers' Compee;sation coverage is unlawful lnd
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 r"
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 i
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. ,� %
Signature (Owner/Agent)' Date J �r'
PERMIT #
BUILDING PERMIT
9907-4071
DATE VALUATION X2241.7152 �fl LOT TRACT 129;12
JOB SItE
ADDRESS " 0493 VIA KAT `t LU A
APN 9-210-006
OWNER
p
CONTRACTOR DESIGNER /ENGINEER
I1 7
I.i3•I,�i �'S }�'k �
iXi%,Ai7moa
./
SPARKS CONSTRUCTIONPO
BOX 1716
79-295 RAMC HO LA QUINTA DR.
L.A QU:1NTA. CA 92253
LA qU WTA. CA 9:2253
(764))7714949 CBTA 2W. 6
USE OF PERMIT
5it`iOLE FAMILY OWFLUNG
SFl7-1.Ca•r 3,.3 PLAN E 1 - PERMIT DOES NOT INCLUDE BLOCK WALL
OR K..9A.. 734NI PLAN CHECK .FE'E RVJ.f1C T1C.1N VOR MdlLI IDLE
VS3UANC E C)1.'. SAME PL.XN 'i"YRf' .
C"J5"fi;rvl G0�1S? i�:iiC'3 i�N g,�:ZS.CN`1 e;F
PORCt f 'A flo 267.00 Sig'
C; 1ARACi1~:/i.:fli PQW1' 614.00 $F
EI ST.tALVIT ID COST OF C OINSTI3I3C1,10 ' .
220.852.00
11VAIN1:1`4 FEESUTt9MARY
a'.SNS"MUC,.TIO'NFlT 1014*10-4114-000 $1.00.(W
III AN('FtF7('S PD-_ 1i)!-f(itl-d?9-i1R $2t;ttn
NIE*C1.1AN.ICAL1711-, $103M
ELEC"i't2ic"AL F I0I-000-420-040 $162.01
PLUMBING E1, 101-00(),419-000 $179.15
6i't'ft0NC4 Nfh'T ION FTN - RESM 101 d011WI-?41-ffln 1572 iR9
ORADING MIM 101.1100-4+23.000 SM-0.no
Ifdi'itai,`;`l UCTUKE1'EE 225-000-443-342 S4,88927
AK11 1N PUBLIC K.ACES • ltK31i; 70.1 -OW -25'x-000 $302.13
$t,Iii-3°(7T'Ai.f't,N`"F'F�.itf[1:t7NANU:F1.ANCIfFif;f~.
IRC, ,65
LESS 3IZE PAID RES
$0.00
F
't'01XL 1tiE,1ZA11`9C F i X—% D UE Nf?W
56,9641.65
RECEIPT
DATE
BY ' f
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
OX to Wrap
F.A.U. - o
Framing
AK X
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
POOLS - SPAS
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
G{�
Appliances
Final
Final C�
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: