9707-133 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed underprovisionsof
Chapter 9 (comme;6ing with Section 7000) of Division 3 of the'Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
JOB
62.40 4
. 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 is not intended.or.off ered 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'
- ,1
I hereby affirm under penalty of perjury one of the following. declarations:
O 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';forlthe .
performance of the work for which this permit is issued.
_ (y) I have'and will maintain workers' compensation insurance, as`reguired by
Section 3700-ontf .Labor Code, for the performance of the work for whi6h-4is
permit., is- issued. My workers': -compensation insurance ,carrier..& policy no are:,
Carrier Policy No.
iarr?:''z�lbaci aY't.?�V" .
'(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;
6 shall not employ any person in any manner so as to become subject to the
'workers' 'compensation laws of California, and agree tha i . hould become
subject to)he workers' compensation,rrrovisions of Section 3700 of, the Labor
Code; Imo, II fo Ith comply withAo� provision
Date `✓� t3/ J Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject.an employer to criminal penalties and civil fines up to $100,0001 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 hist
application. 3 f
1. Each. person upon whose behalf this application is made & each persorrat4P
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 S "aws relating to the bullding� ti
construction, and hereby authorize repress atives of this City to enter upon'
;t!habove mentioned property for inspection purposesnature (Owner/Agent) Date
♦N'
PERMIT# CONTROL# I.
BUILDING PERMIT ,.
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ADDRESS �SITL'h-lS�f} �0 ��.!`PWAA), LN
APN' Ei�al- �sS-fi d
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CONTRACTOR / DESIGNER / ENGINEER
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USE OF PERMIT
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29,35
AUG 28 1997~ �a; �� �� rr� a tar
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C� 1 i OF,L�t �tJIiV 1A _
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-
RECEIPTy
DATE
BY
DATE FINALED
INSPECTOR
•,
f. -
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 & 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
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
t
" Final
Utility Notice (Perm)
COMMENTS:
4727,198
CITY OF LA :QUINTA
INSPECTION SUMMARY REPORT
Permit Number 9707-133
. - Site-Address 78-900 VIA MELODIA
Rereference Number
Site City
Location of Proj ect '
Date Applied for 7/25/97
r
Date Approved
Owner Nam_ e TD DESERT DEV LTD PA '
Date Issued 8/28/97
PO BOX 719 ,
• Date Finaled 4/27/98
' 'LA QUINTA CA 92253
Date Expired
c
'
i
'Contractor Name SPARKS CONSTRUCTION
Valuation $191,739
_ 79295 RANCHO LA QUINTA DR.
'Fees 6,712.08.
LA QUINTA CA 92253
• Description of Permit SFD - VENTANA PLAN V3-3. ART IN PUBLIC PLACES CREDIT OF $229.35-PER AGREEMENT W/
COM. DEV. DEPT. -
INSPECTIONS,
SCH•EDUEED '0 11 COMPLETED
` Scheduled Completed
'
Date Date. ,. Time
Inspection Type Inspection Result -Inspectors Comments f
12/30/97 12/30/97
Ci-LATH PASS
• 12/30/97 12/30/97-
C0-DWN PASS
1/12/98 1/12/98
'
B7-WRAP. .PASS
1/16/98 1/16/98
B8-FRAME PASS '" s
1/23/98 1/23/98
139-INSUL PASS,
2/9/98 2/9/98
CO-DWN PASS
2/ 9/98 2/9/98
C1-LATH PASS
• 3/ 4/98 . 3/4/98
B21-G-TEST. PASS .
3/18/98 3/18/98
DO-E-FINAL SEE NOTES r
• 4/27/98• 4/27/98
y
�D1-G-FINALi PASS
4/27/98 4/27/98
D2-COMP**PASS ,
11 Inspections
completed., '