0008-138 (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
674074 B
Date /f�/ `� Signature of Contrac or-^� " r
t.
OWNER -BUILDER DECLARATION f
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 �D Policy No. A0.4i33a
(This section need. not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this Permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should, become
subject to the workers' compensation provistons of Section 3700 o the Labor
Code, I shall forthwith comply with thosd$rovlslon§ ` .
Date: •f #_� Applicant—
Warning:
Warning: Failure to secure 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 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 this City to enter upon•
the above-mentioned property for inspectjon pwrposlo
s.
Signature (Owner/Agent)'? v Date !''t.
BUILDING PERMIT PERMIT#
30
DATE i VALUATION LOT -1 TRACT
1 t35 .19457-1
JOB SITE
ADDRESS -10-M. 5 VIF ', RS-MWA
APN
649-HW�W
OWNER
CONTRACTOR / DESIGNER / EN (NEER
M DESEW DEVRAPNWIW
SPARKS CONITiRTJCI;t'ON
PO BOX 2716
79-2951 ICS O'LA QXWtADIL
J.,A QTJO `tA CA 92253
1A (S TA CA 9225:
,;760,°171-1941 CSLO, 2996
USE OF PERMIT
SAD- 1.C)T:105 PLAXMW-'Pfr12NIT DOES 1140T INCLUDE OUXK'4v Ll..
OR iEaOO6 75% PLAN tAI•L.8S:2` F99 fIEDUCTION FOR MC1UY1PVK iSSUA O"17
Oar SAME P1,AN TYPt
CUSTOM CONSTRUCTION 4,243,00 Sr
POPICEI &i'i IC, 522.00 SP
W'ARAIRWARPORT (SF) • 13,910.00
.
E.5'i' ,1A11? COST OF cf)1.1'grR'1.icn-ON
3..51 X8.30
PERAMM gtT2 KAR
CONSTRUCTION FEE 101-000-416.000 $15S21.50
'-ry
PL,t%w cird;CK ra 101-000-439.318 $30533
MECHANICAL FEE 101-000.42.1.000
t,LLCTit1CAL WE $246.71
PLUMBINO ISR 161400419-000 $201.00
S;TR.CINO MDTIW4 F TT - RZSID 101-000.241.000 $35,14
cJIMID1 + FFM )01y000-423-000 $20,00
DEVELOPER IMPACT ",Z $3,9rn0
ARTIN PUBLIC PLACLS -' ItE.'�I.0 701-000455-000 8378.47
Ala a
- d
WB-10`lA;t: CORNRLYIrl 10M AWD %r..6' W CW0CX
$4,759.05
1',1 P E -lo AID .C1
+'
• r$WAL JC�3i`1.LT.CS.f F=1 DLTE, �O
NOW
7$0.00
S4b159.05
RECEIPT
DATE j
BYDATE
1
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR!
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ _
Underground Ducts
Forms & Footings
Ducts
Slab Grade
��.�,.y/
%%
Return Air
Steel
Roof Deck
/ l
Combustion Air
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
y 01
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
— �•3
Drywall -Int. Lath
Final
_ _ _ _ _
f�
Final
l
POOLS -SPAS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Q.K. for Finish Plaster
Sewer Lateral�,
(�`
Pool Cover
Sewer Connection
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
Final
/
Utility Notice (Perm)