9907-094 (SFD)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 Exp. Date
67407-i/ S i ��a i i 19"
DateI Signature of Contrac�to4'r
✓ 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'
compensatioh,tas.provided for 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
S tion 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 q Policy No. nnn t
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shaII forthwith comply with those -p ovisions. ( =.....
Date:') l .fir-:� Applicant
Warning: Failurerto 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 Directorof Building and Safety
for, a permit subject to the conditions and restrict ons 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 Ci!tyxd State laws relating to the building
construction, and hereby authorize,represe�tatives of this City to enter upon
the above-mentioned property.for iinspecti9n purposes. -
VSignature (Owner /Agent)i-_ -- G•-^' Dat�
e��='
PERMIT#
BUILDING PERMIT
"07_04
DATE' VALUATION S213,7940LOT `+4 TRACT .25154,
/q/zJOB
Z) r -
SITE
ADDRESS YI9�sS j t' .x�i', Iii
APN 646-323409
09
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SPARKS CONS'T`i'i1JIC'!,IO
PO:WYX 1716
79-295 I2A'NCHO LA QUIN"lA .DR.
LA OWN1A CA 92253
LA QUtN`iA ON 92.25
(7c0;'771-194.1 CTir,.€� Zai
USE OF PERMIT
SINcy►1:.k FAMILxI)WEDIINt r
$00-a.OT,54 'T..X0"V4R PERWIT:DO&$ 40T 3.NC.'LUDF_ BLOC -9 WALL
OR POOL, ,7y.b;PLAN C;i IXX M 2,fa IUCTION frOtL WILY13LE
iSSUANC-'E OR MAE PLAN TYPE.
1.'e�ii�T�''F►i'T.Z3
,
655,00 3F
S"TI!'i'9LSTLsD CMT 01F '1..13£ 4�7 i:RY Y`6.; 1(�d
di.T„Oy J d•'MtY
g��g� tv�g �i
g �`,8 FEE,
GCNSTRUt;`tIONs:'E'C ioi4m)4imoo $L03.3.50
f .A'N C [1 ;r„t<, F103 x211? —14
NIECH,&MCAL M'13 I 101-0m.421.000
MEAY1111CM... Fa, -000
k0:1-112(f,Ut)0 Slei,�:fii:
f_111U:l�IOU40 I� EE 101-iIi 04/94300 t' .35
STRONG 40TT.0N 1, rW 1 RID 10 f, f r9Q-241J
�..�il'�►finC.1'r�Js ltE�,.OfjU-,143-{lf?Q ��ti.f3[1
iN11'.I�./►,;"r MUCTUT031 ills 225-0010-443 34,2 $4,`A6.4 i
t\1:4.'1' [tat p01JO1;fC P>;:AU'S - RL -,,3W 70,t -000.25$-00f3
AND �VLAN CRIECK
�,7!a�•7�
lrc;a $ .?R IPAID -E.ES
MW
=u 14, n . FTC
r 13 -I
"i'[Yuk'[. I';6"m!!'8!'r F. ri : ?"so d i;Ti 6w
�M
RECEIPT
DATE
BY ` )j
If
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
"'
Underground Ducts
Forms 8 Footings
_
Ducts
Slab Grade
PLUMBING APPROVALS
Return Air
Steel
Heater Final
Combustion Air
Roof Deck
z r
Exhaust Fans
O.K to Wrap
O.K. for Finish Plaster
F.A.U.
Framing
Sewer Connection
Compressor
Insulation
p -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
L -10 W_4i Aee
1 :2 r -G
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 _ 06
COMMENTS:
Utility Notice (Gas) 7- W "4 ----
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
5
Notice (Perm)
TOL
o
z'
H
� ��� -
I A ,
, "�,
.�y
'fir.?" JJ. 7v
.. •
..`., 11
�,'�
+,,.Y J•
4
r. I l}.
oOF
iVS
t i
^rt 46 f
�'„
�(.w�� FAX ( )
... ♦" T"- '.
,�
s
� .M1 r. ` b r
T.-..i-....�.. .. r�L l+ J.. Ai�' w�.Ty ..
{ r } r�M' ''. .,t
t',
•�.`S^
al r.
E?
M
• u`'.s
S. Lor �.. i" ' .�. _.r �A
+, - +,/• r .v`. r
•'rim
`` (
E
r
;
r',; - Irrl�
� ';
�i,
Y ~
{' � '��"
t..+ .,� aP ,.• ,., _
.
r iy t "r^ ,� 1.
Poo
L/* s Vic a-
E;
A
R i
Aw 9;.sv✓wcf' ,41 tzC
aY r r'
1 •
w �!•
�Jr{,/"���.5qq,,7�'C,�.. >. -�� ,.r 7' .�.Yi
r ! `�". '}�.r{ • .
.. 1{
+,+ A•l. .,
��•yer� �
h., �1 7�. fi{
h�
ii t �� kf`
_
�r
0.
.i T• r!1�,''[f 1
t�1.ii
g - �. `�� « . -
TOL
DAjIb //,0
z'
H
"
�`
-V a' ,
-CELL'E`�-3 D)
oOF
iVS
�(.w�� FAX ( )
Nji
� -f � _. {.:
T.-..i-....�.. .. r�L l+ J.. Ai�' w�.Ty ..
.,r •f ,.
E?
M
•'rim
`` (
E
1
7
TOL
DAjIb //,0
TIME
PM
H
-FROM'-'
664
-CELL'E`�-3 D)
oOF
iVS
�(.w�� FAX ( )
Nji
� -f � _. {.:
T.-..i-....�.. .. r�L l+ J.. Ai�' w�.Ty ..
.,r •f ,.
E?
M
E
r ty� •' �•,I r •
?
s S
Poo
L/* s Vic a-
E;
A
R i
Aw 9;.sv✓wcf' ,41 tzC
S77 6
M
E
% A2!' (N
Ari► .L Al� Aq— . `)743 too.f.
.
0.
E-MAILADDRESS
SIGNED ^� ,
PHONED❑
BACK❑
CLC RETURNED[]
SEE YOI WANTS U
AGILL AIN CALL 0;
WAS IN ❑,
URGENT❑
�T.-.'✓r�.rJ�. �
�ww..�R.1
,
� -f � _. {.:
T.-..i-....�.. .. r�L l+ J.. Ai�' w�.Ty ..
.,r •f ,.
'
r ty� •' �•,I r •
y
... as ;-+.
J4 r.
•1. t ! � •�y� �,• �' - r!•S
� ,
r _T T.��.7
- •Y{
.x
:,ate
1�.
t �1.. yr
... ''x.
,
y�'
•
l..i
i
♦
iyrr. r 1"� t..
` 4 .7 .�.. ,..1� �s: ;4
+.
•
• j
.�
K'� r-
'�
. i
r r _ .• r�r:
i, ` r 1 x .•
r
.i 1
, ♦$
•.,
s� •-
}
; 1', r • }+'- �L yr�. • L. - ..
` � ~.
4!
.a 7' i.
. '
♦ 4
t
�
x
' '
rh. 41 1 1 ! ,. 'r.i 4� �t S� S•i„�.
.. . .
i