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LICENSED'CONTRACTOR DECLARATION ,jam
I hereby affirm' -under penalty of perjury that I am licensed under provisions of
Chapter 9'(comencing with Section 7000) of Division 3 of the Business and
Professionals Code, and,my License is in full force and effect.
License 1# y Lic..`Class Exp. Date rt
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BUILDING :PERMIT PERMIT#
DATE /t VALUATION .�s 1.1p24ZO LOT Z63 TRACT 294$7�2
JOB SITE ADDRESS 4' 9 370 V.�+�JTA .�'c��i4�aS�inS0X1 APN 45494.00
Date„ , Signature of Contractor OWNER
OWNER -BUILDER DECLARATION
I hereby affirm under penalty -of perjury that I am exempt from the Contractor's PC)1'_O"1 71
License Law for the following reason: 1 iii%til tir"►
( ) • 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
CONTRACTOR/DESIGNER/EN (NEER
CIA 92251fi 'x Q.z a, 2
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0'60)7?1-1 41 CRIA 2996
sale (Sec. 7044, Business & Professionals Code).
USE OF PERMIT s,
( ) I, as owner of the property, am exclusively contracting with licensed
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contractors to construct the project'(Sec. 7044, Business & Professionals
Code). °
,;'M » i,.OT '33 PLAN MIRbbi:3Cf. P12.rJIT DO23. NOT rNC:i,,f.)DE RIX)C K,,
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() I am exempi under Section B&P.C. for this reason
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Date 4 Signature of Owner
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WORKER'S COMPENSATION DECLARATION
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I hereby affirm .under penalty of perjury one of•the following declarations:
, M nTION .3,712,00 8F
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I have and'will maintain a certificate of consent to self -insure for workers'
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compensation, as provided for by Section 3700 of the Labor Code, for the
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performance of the work for which this permit is issued.
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I have and will maintain workers' compensation insurance, as required by
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Section 3700 of the Labor Code, for the performance of the work for which.this
compensation insurance &
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permit is.issued: My workers' carrier policy no. are:.
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Cartier STATE FUND Policy No. W-0607338
MW.AIED COST OF C0MMUCT°.SON
3i21024.60
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(This section need not be completed if the permit valuation is for $100.00 or less).
b:ONST'RUCT'19N ME( 101.000.418,000
(.) I certify that in the performance of the work for which this permit is issued,
PLAN tyii tak`; ij , 3286;4
I shall notemploy any person in any manner so as to become subject to the
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workers' compensation laws of California, and agree that if I should become
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subject to the workers' compensation provisions of Section 3700 of the Labor
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Code, I shall forthwith comply with those provisions.
P1 UMB)NO F ,F 1(57.0000 13.��(;LTd �` 6.25
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Date: Applicant
YRL:NO ik O 1K3�d,TFEiB � kf~SiF9 7€11-00044.1-1).00
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Warning: Failure to secure Workers'.Compensation coverage is unlawful and
4�Ftia1l�ICi1�1; 101 -.00423000DFV
shall subject an employer to criminal penalties and civil fines up`to•$100,000, infl
X?rii�>� IMPACT M,
addition to the cost of compensation, damages as provided for in Section•3706 .
� 1 1 �� �.4: PI.�?►af' - iC.ERIE 270.000-445.000 fs2�C,iPfS
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of the Labor. Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety.
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for a permit subject to the conditions and restrictions set forth on his 4
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application.
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1: Each person upon whose behalf this r application is made &each person at.f�1W?
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Whose request and for whose benefit work is performed under or pursuant to
any permit issued as a resultpof this applicator agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
Any permit issued as a result of this application becomes null and void if
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D NES VI31' NONVY
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$4,542AI
Work is not commenced within 180 days from date of issuance of such
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APR �) 2001
permit, or cessation of work for 180 days will subject permit to cancellation.
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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
'
1000FLAQUINTA
construction, and hereby authorize representatives of this City to enter upon ,.
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the above-mentioned property for inspection purposes. 3
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RECEIPT DATE
DATE'FINALED
Y•-
INSPECTO
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_.Qnature (Owner/Agent) t`; Date—
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z
Underground Ducts
Forms & Footings
- % -
Ducts
Slab Grade
I
Return Air
Steel
_ _ Z
Combustion Air
Roof Deck
3 - _Z
Exhaust Fans
O.K. to Wrap
de _25-Z
F.A.U.
Framing
-
Compressor
Insulation
- -Z,
Vents
Fireplace P.L.
I
Grills
Fireplace T.O.
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Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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Final - Z -
Final!(g..
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
1
Electric Bond
Footings
I
Main Drain
Bond Beam
1
Approval to Cover
I
Equipment Location
i
Underground Electric
I
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Top Out
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Plumbing Final r
Equipment Enclosure
Shower Pans
Sewer Lateral
_
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O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
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Appliances
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Final
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COMMENTS:
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Final
Utility Notice (Gas)_ _
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit ,
Rough Wiring
Low Voltage Wiring ,
Fbdures I
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power I
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Final
Utility Notice (Perm) .� ✓
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.� _..C.ILY ,F LA QUINTA i
cFyoF��o � BUjI` DING��. ,AFETY DEPARTMENT .
Y - 11777-7012
•� � ,,•_i' •�� �� ���S�PEC�QN REQUEST LINE
-4 777-7153
Ow
ner ; f D' DSRT PEVELOPMENT.
Contractor SPARKS CONSTRUCTION
_ Permit Number 0111-200
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR. MUST SIGN ALL APPLICABLE SPACES
JOB DRESS 1 n r� � � ulq�'I. -... �
�p?6Ti SFDLOTN3PLANfM1RM3GPERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA, OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK -
FOOTING STEEL _
MAIN GROUND SYSTEM
GROUND PLUMBING /
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN S GNED
CONCRETE SLAB - ' �; • - �,
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L ..CJT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SI NED
ROUGH ELECTRIC %j/ - 2.3 2 -
ROUGH
ROUGH PLUMBING
ROUGH GAS & GAS TEST
r HEATING. & VENT - A/C - -
FIREPLACE i
ROOF
BOND BEAM
O.K. TO WRAP 2
GROUT O 4' ❑ 8'
FRAMING
INSULATION !� -
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN S ED
DRYWALL INTERIOR
EXTERIOR LATH. .
POOL PRE PLASTER
r POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS i
ELECTRICAL i — o
PLUMBING
FINAL GAS TEST -
H' --ITI NG - A/C
1•. -SSE NUMBERS
JOB COMPLETED -
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO ,
TURN ON UTILITIES OR OCCUPY BUILDING
xertificate of Occupancy
City o.f La Q
Building and Safety Department OF�
This Certificate issued pursuant to the requirements of .Section 109 of the Uniform Building Code,
certifying that, at the ttime of issuance, this structure was in compliance. with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 49 -370 -VISTA MIRASOL
Use Classification: SINGLE FAMILY DWELLING Bldg! Permit No.: 0111-200
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
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