0111-198 (SFD)_ LICENSED CONTRACTOR DECLARATION
|he,eby affirm under penalty of perjury that |amlicensed under provisions of
C nd with Section 700oofDivision 3ofthe Business and
Pmfeoaiono|xCodo.ondmyLioonooiom�!|honmand effect.
uvennv#- Aic.o/oas Exp. Date
.
Signature of Contractor
OWNER -BUILDER DECIJ�RAITION
I hereby affirm under penalty of perjury that I arn exempt from the Contractor's
` .
( )
1, as owne,ofmoproperty,mmyemployees with wageo,as their sole
compensation, will dothe work, and the structure ionot intended o,offered for
sale (Sov.ro44.business uProfessionals Codo).
( ) |, as owner o/ the property, am exclusively contracting with |ioonood
contractors to Construct the project, (Sec. 70*4. 8uuinooa 8 Professionals
Code).
()|omexempt under Section ' '�.a&P.C.for this reason
_____�_�_
Date Signature o/ Owner
'vvOnmsn'S COMPENSATIONDECLuRATOm
| hereby. affirm under penalty of perjury one o/ the following 'declarations:
.( ) |x�eand vw||ma��nooemnu�ecdoonuemmoox��
nuu,xxm�
woe,
componsatiun.'osprovided for. by Section 3700 of the Labor CoUe, for the,
performance cxthe work for which this permiti issued.
)I have and will maintain workers' compensation immranno, as required by
3700 of the Labor Code, for the of the work for which this
permit is issued. My workers' compensation inovmnoo carrier & policy no.are';
Carrier Policy No. `^
(This section . need not Uacompleted ifthe, permit valuation is for $1O006mless�.
() | certify that inthe performance ovthe work for which this permit ioissued,
|anon nmomp|oyany pomYDinany mannoconaotnbecome ou��
subject to
rkers' compensation W ��California, and
Date:f`,_-f Applicant
Warning: Failure to se�cu re, 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.
|�a� ' /
ER
DATE VALUATION LOT TRACT
29457-2
JOB SITE'
APN
ADDRESS
OWNER
CONTRACTOR DESIGNER EN61NEER
MINIMS CONS1511-ITCH-014
USE OF PERMIT
POOL. SPA, OR. 0*11VEWAYAPPROACH.
CUSTOM CONSTRUCTION V40D UF
ftR.A0rUCAAP0qT 8,11F
CONSTRUCTION ME 101 -000-41 8_0M $1,280,00
Mrck"NICAL FU 101 -MO -421-000 $149.50"
,ART IN PUBLIC PLACES RMIE 270-000-445-000 1205.27
TOT
DATE
BY
FIN
I NZ!C TOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
f
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
j mom-
Underground Ducts
Forms & Footings
-�� i o y S
���v
Ducts
Slab Grade
Return Air
y /G ^Z_
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
.�/ �B -
_l�= -
F.A.U.
Compressor
Insuiation
y `/9- z S
vents
Fireplace P.L._
-�
Grills
Fireplace T.O.
_
Fans 8 Controls
Party Wall Insulation
_
Condensate Lines
2Z
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
I
Equipment Location
Underground Electric
Underground Plbg. Test
Final
'
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water PipingB
71
Heater Final
Plumbing Final
Plumbing Top Out
-/G - z
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ _
/ ��D
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
I
Gas Test
Appliances
4
Final
I
COMMENTS:
Final
I
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
i
Underground Conduit
Rough Wiring/6L-IB
.
Low Voltage Wiring
Fixtures
j
'
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
I
Final
Utility Notice (Perm)
,
Wcertific'ate of Occupancy T
.�
O
o� o
City Of LQuinta
5
Building and Safety Department OF
}
This' Certificate issued pursuant to the requirements of Section. 109 of the Uniform *Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction .or use. For the following.-
BUILDING
ol%wing:BUILDING ADDRESS: 49-350 VISTA MIRASOL
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No. 0111-198
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL.
Owner of Building; SPARKS CONSTRUCTION Address: 79-295 RANCHO LA:QUINTA
City: LA QUINTA CA. 92253
By: GARY SHOWALTER
Date: 08/06/02 .
Building Official
POST IN A CONSPICUOUS PLACE