9601-134 (SATT)c/) LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
CNJ (n
LU Section 7000) of Division 3 of the Business and Professionals Code, and my
C:) O Lo License is in full'force and effect. 6174074 ? B 7/3.1/97
r W ^ License #/ Lic. Class Date f �,
Date ;2 /r�.J+ty , SignatureofContractor/�
-
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o� ZO 1 r
CID rn OWNER -BUILDER DECLARATION"
J wCD
1 hereby affirm that I am exempt from the Contractor's License Law for the
a 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).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
LON
O CNJ
rn - •WORKER'S COMPENSATION DECLARATION
dQ I hereby affirm under penalty of perjury one of the following declarations:
Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
Lo �< cc compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL performance of the work for which this permit is issued.
p J _J () I have and will maintain workers' compensation insurance, as required by
m Q USection 3700 of the Labor Code, for the performance of the work for which this
O U permit is issued. My workers' compensation insurance carrier & policy no. are:
a rn �<_ Carrier Policy No.
I Z (This section�neednst be completed if the permit valuation.1s•for $100.00 or less).
00 D 14cy (.) 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, l shall forthwith comply with those provisi no s. - ---+�
Date: 0/�r`''4_1 Applicant < 4 L. _11
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as,�aresult ofthi6,gppIir tion revs to,A shall, indemnify
& hold harmless the CARLI di el '�6flfi0 rs, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize repr!pentatives of this City to enter upon' the
• above-mentioned property for inspection purposes.
Signature (Owner/Agent) `r i Date 7 f�✓F��%i�
ALCM
BUILDING PERMIT
PE111"9401434
DATE J/170(/
VALUATION L (�,; ,. yl LOT
TRACT 2'!!$A�
JOB SITE ADDRESS
'48-024) VIA tA�,L�1.lri"�'E\ �
APN
649-3911-4102
OWNER
CONTRACTOR
SPARKS CONS'! I-MCT1(
TU. DESI 12I' YET VELOPMENT LP
101. NVAU',170N T3RIDGI;? R.01,40.
P.O. BOX 1716
LA QU1NTA CA 92253
LA QU3NTA. C.A. 92).53
(619) 771-.041. (..R 2-096
(619)77Y -1'M IDESIGNERlENGINEER
PE AiiFJs-CRAT' DELL. 10C.
23672 BIWIV IitR 011.
USE OF PERM ISING E 1FAIM71. a.'' MT1.AMED
T Ti'se u-Apvwr t' ik C"54%1. , s 'p�
RANCHO LA C)t1fal'A.
CASITASDI.i'P1 EXPLAN A
FEE DESCRIPTION
FEES
CUSTOM CONSTRUCTION ION 1,725.00 L1:
�^
P RC;HMATIO 200,00 4F
GA12AGE(CARPORT 467:00 Sl,
ESTIMATED COST OF CONSTRUCTION
146,190.70
PLAN CHECK IFFE, 101 -M -439-3.M_ SMA.29
CONI STR CTION "r"F.:R . 101-000-418.000 5 .
fvEF'CHAKICAL FEE, 101-000-421-000 568.50
PLEC 1 R1C:AL F'EE 101-000-420-(100 $133.22
PIA VV17d't' IrEF11 101,.000 -4e.9 -00t) . $1 ti' 1.00
STOIdG, MOT-1koN MIR ..1t1✓S10 100400-241-000. $ 2.13.62
01t2ANNO FE 101-000-C23-(1(h:I. $20.00
110':11;A.`;'.1RUC,"1(J1Z.E.FEF 225-000-443-342. $x.229.44
AFT 1NPUBLIC PLACOS - RESID, 701-000-2-55.000 $115,48
SUB-1WAL CONS'1'RLJCri(. m AND PLAN CHECK
$5,205.55
1.1aS�a P111,-PAUD 1" MS
$0.00
U O'.CAL PERMIT #EES DUTE NOW
FEB 1-4 1996
RECEIPT
DATE
BY
It
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
5 -2 -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
-41
Final
Final I I
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
01K
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
Gt'
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
�� a1 Lt! 2 2AIM
�Y 2