0008-102 (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 # Lip. Class Exp. Date
04074• B
Dated «-%' Signature of Contractors
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
( ) 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 T
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 ILLI ID Policy No. God 00OZ318
(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, 2nd agree that if I should become
subject to the^workers' compensation 'provisions�of Section 370016f the Labor
Code, I shallrforthwith comply with tfiose provisions.
Date: %a Applicant—
Warning:
pplicant Warning: Failure to secure Workers',Gompensation 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 aupOriz`e representatives.. -,of this City to 'enter upon
the above-mentioned property for inspectionpurpo�s'e�s
Signature (Owner/Agent)-f ! 1 Date' r Z�
BUILDING PERMIT PERMIT#
0 00' 1.tY
DATE
ft�� VALUATION LOT TRACT
2.94 57 -
JOB SITE'
ADDRESS 48"7"V1&rA1��"�:1�E,LA
APN
., •649'.1
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TD Til.;MRt DLENJ )CAIMENT
SPARKS CON=T 7'=014
PO BOX 1716
-19.795 WO -1 ? LA. QUU-TTAD?F.
LAQU—.D4TA CAS 92253
LAQCil?riA. CA 92253
(760)771.1941 C -SI., 2996
USE OF PERMIT
OLE F'AIt?XY DWl ;Z.i.I %TCi
Sin. LA)T-69,PL.AX:hl.2 * P9M1T 11=4 NOT 114CL.l-fDE BW1CV.VALL S OR
POOL 73% PWa CHECK Fi;R_'REDUCi iON FOR KUTAiPLLi I931JANC"P OF
SAME PLA4 TYPE.
CUSTOM CONSTRUCTION 3F
PCSAt:>`iIPATlL7 446.00 SIS
y QA_RWFJCARPORi(8F) 12,465,00
•-.. �'`aS}'7�� WfED COST OF COSM, !70'1TO1d
2515,40
yy )•p y; 7, •y/�,,
gONSTROCTION FEE 101.000.418-000 $1,325,50
PLAN CYNIC FEE 101X000-439-318
MECHA141CIAL PEP 101.000.421.000 $124.00
111 h"
1,LPZTR IC,AL FEE 101-000-420-000 $221.18
.
PLUMB= KE 101-000-419-000 X229,00
STLtt NO INIDTION FEE < R0SID. 101-000-241-000 $24.54
„r �.:
GRADW # FER 101-000-42,1-000 $20.04
BEV2LOPLT.R IMPACTME $190.00
AIT IN PU13LTC PGA.0 E.S - RUM 701.000-,255.000
3ii}, .1WAL CONS -1 AA1D PLAN CWXK
Y�8 .1' PA 1D .1 �
"$0:041
rA,V��`�Y�.+.! Xiaff A .S:uT N -./UE' ROYFr
AEN
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iaikF.f
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RECEIPT
DATE i
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/
�CO
Underground Ducts
Forms & Footings
U�
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
/
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
'
Exterior Lath
Drywall - Int. Lath
Final
�J70f
Final
13001 -9 - PAS
BLOCKWAL/L
APPROVALS
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
��=�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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
Finale_
Utility Notice (Perm)
EA_POW-0