0008-142 (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
i
Date `fir{•••' Signature of Contractor %r
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:
Carver STAT FUND Policy No. 046-00=38
(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 mannerso as to become subject to the
workers' compensation laws of California, A 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 prow &ions.
Dater / R',.',_ Applicaht
Warning: Failure to secure'W..orkers%-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 is City to enter upon
the above-mentioned property •inspection purposes''
Signature (Owner/Agent)- ° ' Date'"��
BUILDING PERMIT PERMIT #
la04 �E2
9.
DATE � VALUATION LOT TRACT
0i SI. 1338J0 a0,1V 29457-I
JOB SITE! I
APN
ADDRESS,tM15 1 T,AX&1'Rr:3;a
6494M
OWNER
CONTRACTOR /DESIGNER / EN (NEER
M .t -MX IYEd, OPW34T
SPARKS Cr'C7N IR MON
FO Dox, 1'l 16
79-x95 RNCHP -Uh QUiI`i'. A DR, '
LA Qti.IDUA CA 92353
LAi QTJMTA CA. 922153
Q60)771m1941 CU4 2996 .
USE OF PERMIT
{ ���yy qy p{��yy�y �, ry
k7.T.rt'17ix. Ft'�.(.40.11_ iJi�iTZ..'LsLa11\!\J
'
SFDi LOTA09 PLAN.M3R - Pi ILMI T DOES NOT INCLUDE BLOCKWAL..i..S
OR POOL, 750/4 PLAN CH9,01C FBI?, RODUCTION FOR MULTIPLE iPLE ISSUA1! CE
OF SAIAZ PLAN TYPE,
CUBT.OM Cpl+ 3TRUC°TION 4,243,00 OF
PORCHIPA' 10 3.22,00 S.1±
C#A.RAMCARPORT (o3Fj 13,916.00
ZSMIATED CO.7f OF COM%ti?CWOR
381FWM
CONSTRUCTION FU 10'1.00,0-418.000 511521150
1,,
PUN CHECK FE& 101 w000-439-318
E :.. # �.
MECFIA.NICAL IEEE 101,z000p421,i000 $196,50
a
ELFZTRICAL FF -9 101»000-42"00
PLUMBINo ME 101-000.419.000 $20$.0001.°
f ,
STRONG !MOTION ISE a K$SID 101-00-241-000 M.14
%q
ORApINO FEE 10.1-000-423.000 $20,00
7 � •
Di '1?I:>OPt. IMPACT PRE
.ART IN PUBLIC; PLACES" R.F,gii701-000n255?WO $ ,4i
SUI—R T ITAL i;OH.& RUC I -10)q ARD :f T� A4d CI3 W -X
$4,759.01
1.03 PRERPFIM
$0.00
TOfAl PMRMUY ECEIN DITE. NOW
$44759,05
RECEIPT
DATEt ff
BY
'11,17-111
DATE FINALED
INSPECTOR
d �' t 7
INSPECTION RECORD -
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
��
Underground Ducts
Forms & Footings
r/
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap�r
f
F.A.U.
Framing
/ a
Compressor
Insulation
-
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
14
Exterior Lath
Drywall - Int. Lath
_ _(
Final
/
�—
Final
POOLW-PAS
BLOCKWALL AP ROVALS
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
2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Qom,
Pool Cover
Sewer Connection
/ ��'�'~�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
MMENTS:
Final
Utility Notice (Gas)
,
ELECTr%,r%A1 APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
1�
Temp. Use of Power
Final
Utility Notice (Perm)
- d(