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0002-136 (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 Date % ' `' Signature of Contractor. i',."�' _. OWNER=BUILDER DECLARATION I hereby affirm,under penalty of perjury that I am exempt from the Contractors 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' compensation, as 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 Section 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: CarrierPolicy No. S'i .1'Pls rU%ID O 338 (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 mannerrso" �s to become subject to the workers' compensation laws of California and agree that if I should become subject to A wofkers' compensation provisions of Section' 3700 of a Labor Code, I steal forthwith comply wit6hose'provisions. i 61 �'�ir' APPlicant (... - Date: � � �, Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. ' IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions 'and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to ,any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is . Correct. I agree to comply with all City, and -State laws relating to the building construction, and herebyauthorize representatives of *this City to enter ,upon the above- menti onedproperty for,in�pection��urp_os > Signature (Owner/Agent) LDate �( ()'j BUILDING PERMIT PERMIT#fDdk�—�.:9 MATE VALUATION Sx�t��'>. �} -7• 10 LOT ' 3 7 TRACT 29306 JOB ADDRESS 43-2550 �6 :li'4.�.�. CALICO APN OWNER CONTRACTOR/DESIGNER/ENGINEER ! #"11'�1JCt Y9'i' fll.tlT.'T PSOA C." i' P l .t;,r d..ti411..1 AL6. ♦.:rd.H„II r�f,r,�dl �t7 � pC.f''P1leX�"Y' riI'N'6 'I'A'A U4 P0130 0-716 - 79-295 114iivt;HO A QUI14 A DR.. -t.A.0U?N'!A CA 92253 LAQUTWI-A. CA 922,53 060)771.-1941 �',MI.11 2996 USE OF PERMIT SiBVG—LE FAlvi1.Uk MEL 11N6 :r�:cs-s C?T3 7 PL Mt 201.R-1;MtCvtrf 00 VS 140i iNC'3 UDiR 1"L4,3CK 1WA...!XS OR PQ ,I `7w�+. ,1'1,8N, c. (::1; 3,.8,E tW,VUC TION 1;C..R A�ffJ€ ` t0...81JSU'ANCIS Ola' ' SAIME— 1-11iA V'i Lrlj:ti ' .°.t�.I NJCvS c;.Ul..A lt1t`Lt 49N.00 S (JARAQE'$ ;Afc1-k)JK ' 4'70.(* Si RtS TIMATED COST OF O01` YTRtEiCTION 24%117.10 D'.;a�afd4#'t"33'lrIIi� �i}3tFlI9'L.EAfl�'1` C' ONSa'1`12UCTTONFhE- 101.000-418-00(1 a2>i33.G� Pl,.AN (74 C;K IFFE, 1101-000-419-318 lay . UA'N`tr:11L.M1 101-000-423.000 $130.50 UEi''7`E.FC:ALJ'iE;E 405-000-4204M $ 69, T+1;USvl.iitNLr3'1:3d If}:t 00ti-c419-000 �li5.T,5 5'1•'RC?T.tfa �9i'3'f'It1jJ F�� ;f2F�ifll 1,f11.-t1!}0-�ci1-t100 �^4 �f1 \Jllf'I)A.`14:f S,'d.:.W '�W1,"•UVV^yGJ'V1lV T4.V.,.FJ DL- Vf1LUfFIER 1Id4f2AC'l' f 8 r 3 •lil7.0ii Af,CT 11%1 PU:RLfC PLA; FS - RESIC 701 W)-7, 5-000 $t5i�.29 �! ��S-'�GJ's A�, t�f���'T�6J�"!'►•�>��;�,N;? ��:►•A��!ylf�ii�{:�.�, s RECEIPT DATE B� DATE FIN L INSPE TOR INSPECTION RECORD 4 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings —bQ Underground Ducts Ducts Slab Grade j 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 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 I I Gas Piping PLUMBING APPROVALS _ Waste Lines Gas Test Electric Final 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 Final / Utility Notice (Perm) COMMENTS: + 6' 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 674074 P : U7/:i l /2( 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 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 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' compensation''as 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 Section 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 STATE FIND Policy No. 043.0007.0 (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 shall forthwith comply with those provisions. Date: Applicant 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 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 State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# 0002-136 .. DATE TRACT +� 0410flOC VALUATION A�A0e1 A 7.10 LOT 37 29306 JOB SITE ADDRESS VISTA a x�0 APN 649-1(0019 OWNER - CONTRACTOR / DESIGNER / ENGINEER M £iFMRT DEVELOPA?MTf SPARKS CONSTRUCTION PQ, BOX 1716 79.295 RANCI-10 LA QUMiTA DK. LA(3Uw T.A CA 92273 LAC:WN--T.A CA 92213 (?60)%? 1 m1941 0" .2996 USE[ Ov1gF1yPERMIT A�/(�j r�j�jIyp��r%� WNGIB J. IiL mllf D YT.L..+M..fI.L'u V - SfPI7 I..OT 37 PIAN E20R- PEMIT DJOES NOT INC LUIX0, BLOCK i,'s}'A As OR f'001.75% € LAN CHECK .FEE REDUCTION ICOR MULTIPLE ISSUANCE O . ;lAi.MF PLAN TYPE. CUS'1'C M C014;TRUIC fJON 024,00 3F PORCH/PATIO 233.00 SF OARAOMARPOwr 410,00 SF ESTOdA17:U COST OF Ct3:£(iSTUMION 240,117.10 Mafff EE srtbD4ARx C0143'rRUCT1OA FEE 101.000-418-000 $16133.00 PLAN CHECK ,FEE 101-000-439-31$ $232,24 MECHANICAL YEE 101.000-421000 $13015,0 KN IXTPJC.t 1, FEE 101 -000 -.420 -WO $160.24 PLUS BIX0 FEE 101-000-419-000 817.103 STRONO MOTION NEE - RIEStiJ 101-000-241-M $24.01 GRADING PER i o l -(100423.000 $20.00 1)EV9LOPBR IMPACT FEE $1,907.00 ARS' TIq PU13LIC PLACES - RESK 701.000-255=000 $35U9 SUB 1'C71.4,1'. COA3'S'I'RITO ION AIMPLAN C",k=1R, T4,142.03 LEZZ P:IZE:-#'AID "MEN $0,00 't'MAL P=4.r FX26YOF NOW $4,14103 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs a Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck pn/— Exhaust Fans O.K. to Wrap _ /`— F.A.U. Framing Compressor Insulation- I G� 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 FPROVALS POOLSI- 9PAS ' BLOCKWALL steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I 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 COMMENTS: �e,..s vit 6iJ 'p—Z9— b 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 Final � .J Utility Notice (Perm)