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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
0474 U 1"
ID17
e� i =� Signature of Contracto
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OWNER -BUILD R:DEC ARATION �.
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).
O I am exempt under Section - B&P.C. for this reason .
Date, Signature of Owner
WORKER'S COMPENSATION DECLARATION
1 :hereby affirm under penalty of`perjury'one ofthe 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, for the
performance of the work for which this permit is issued ;
Sec( ,) I have and will maintain workers' compensation insurance,.as required by
ion 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.
S 'ATIZ FUND; ri i7T338
(This section need not be completed if the permit valuation is for. $100.00'or'less).
(.)..l certify that'in the performance of the work for which this permit is issued;
I shall not employ any persomin any manner so. as to become subject to'the
Workers' compensation laws of California, and agree ^that if I -should become
subject toy e workers' compensation provislonnp,of Sect(n 3100 -of the Labor
Code, I shall forthwith comply with tohose-pro`uislons:' C ,
is �cic /I.
ate: V f / Applicant
Warning: Failure ';o secure Workers' Co ensation coverage is unlawl land
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 a's 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 1` 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 autho�rizexepresent1tives of this City to enter upon,.,
the above-mentioned property for�inspectio�n pur�,
`Signature (Owner/Ag f) C. Date �I4"�
.
PERMIT #'
BUILDING PERMIT
"07AW
DATE VALUATION S21X 93 40 LOT 32 TRACT y51 S4
JOB SITff ADDRE� S 8. 95.5 VIA V 0 : INA
APN 64&331-024
OWNER •
CONTRACTOR/DESIGNER/ENGINEER
.'.rl) I RS1 RT rXIVE]1 OFIP I.�Vi'
SPARKS CONSTRUC;itION
PO BOX 1716
79495 R \NC:14.0 LA QUIN r'A. DR.
`IA QLRW`('4 CAA 92253
L.A. QUINTA CA 92253
USE OFFPERMIT
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IN KH
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
` -A, q A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
�. lei
Return Air
Steel
Combustion Air
Roof Deck
. Gj
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
- �_ /'J
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
A 17-11,
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 Pibg. 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) r%
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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