0008-097 (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 -- Exb;. Date
B ,pi 07/31M
Date �.8 '!� Signature of Contractor
OWNER -BUILDER
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). '
( ) 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 FUND Policy No.
(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 as1to becorii a 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�4hose pro�isio�ns. J
Date: Applicant
Warning: Failure to secure Workers' Compen ation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up tc $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 allrGityNand State. laws relating to the building
construction, and hereby authorize representative.s of thi City to enter upon
the above-mentioned property for inspect on purposes.` /
Signature (Owner/Agent)'" Date r
,. .
BUILDING PERMIT PERMIT#
DATE ; VALUATION LOT OWS-097 TRACT
►.. �`� ICU 44051, T.30 54 29457-1
JOB SITE i i
ADDRESS 48•-690 VI4S AXSDOML.A.
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER.
M I3EaRf DEVELOP TT
SPARKS CONS3.TRUCYTON
PO BOX 3716
79495 RtANCF101A Q1.17NTA,DR,
LA QUft4TA CA 92253
rA QUINTA CA 92253
(760)771-1941 CB110 2995
USE OF PERMIT
SWOLEF 1:6.,Y D'bVII LWG
SPO, LOT;WPLAN03 . PZRIt 91T JDO&`+ NOT INCLUDE BLD. C1.' WAL.LS Olt
POO. 75% PLAN CHECK FEE RYDUCT10W FOR tAlI ,TIP,E ISSUANCHb?
Lr PLA14 TYft. 4
CUSTOM COWSTRUCTION 4,243,0D 3F
PORC11IPXf10 ' , 521.00 SF
OARA(3FJCARPOR.T (SF) MOM
FA7'TMATR*D COST OF CONTMUC rIOX
3511398.130
8.:50
PERMIT F= 90ADURY
COMTRUCT1014 FEF 101.000-418.000 $1,521,"
PI.,AN CHECK FEE 901-000-439-318 $irsFi.fia
*00
MECHANICAL, FES 101.000-421.000 3130."S0
VLECPRICAL,ME 101-000-420-000 $246.71
PLUMBINO FEE 101.000.419.000 $205,40,
;r» I
STRONG, MOTION LEL - RESID 101-000-241-000 $35.14
t
k- �1
DING FEE 101-000-4231-000 $20.00
0EV9L,OP9R IAJ' PACT FE1? $1,9i1?.00
r; •_
ART IN PUBLIC PLACES - kES11: 701.000.255.000 $,.M,4'7
' 4)
91113=!'C9'i'AL. C10N,97 .T7G`iY ON Ate 0 PLA.14 CRECY
LESS Mt PATD.FM.
som
TUML PKIM ' DUE NOW
RECEIPT
•
DATEI ! l `
r ; jai ;s..
BY "
DATE FINALED
INSPECTOR
.
INSPECTION RECORD
OPERATION j
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
XG/ _
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
_
POOL - .vPAS
BLOCKWAL AM
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 Z -/Z-
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/
Pool Cover
Sewer Connection
elg)w
Encapsulation
Gas Piping
Gas Test
7
Appliances
Final
COMMENTS:
Final
Utility Notice
(Gas)
ELECTRIC
A PROVALS
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 Noticz (Perm)