0008-115 (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 J, .� Ep-D to
E'404 #3
Date .r` Signature of Contractor—
OWNER-BUILDER
ontractor OWNER -BUILDER DECLARATION �.
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) .1, 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 ISignature' 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 SLATE FUND Policy No. 046-007J'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 manner so,as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to th°e workers' compensation provisions of Section`3700 of the Labor
Code, 1 shall forthwith comply with, those provisions.
Date: '7 ' �iJo.' Applicant
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 inspection purposes.
Signature (Owner/Agent),- w A' -' Date
BUILDING PERMIT PERMIT"
DATE f - VALUATION LOT TRACT
W2,106,00 .82 294,57.1
JOB SITEAPN
ADDRESS 49�_wo Yq� ismEsmaja ...
OWNER
CONTRACTOR / DESIGNER / ENGINEER
`ED MIERT iG.1;VI;2~QP1 i7.
SPARK9 C 014MUMOX
PO BOX 1716
79^295 :ItAMMO 1A QUWADR.,
7.A QUIl;I'1.A CA 9225
TSA QUD4TTA CA 02253
(766)771-1941 C. 2996
USE OF PERMIT
M4C0r.Z, FAMMY D r R4G:
SYD- LOT;22 PLA2d MI , PERMIT DOES NOT INCLUDE BLOCK -WALLS OR
P00 A%PLAN CHWK. FEEMEDUfTION FOR MULTIPLE ISSUA34Ct? OF
SAMPo PI:.AN `I YPE,
C:UROM C01143TROCTION ';348.00 OF
PORCHIPATIO 580.00 Sip
0Ait,AGMAP..PORT (9F) 13,532.00
9`- 7
tj
COW OF CvOMMOC'2'SON
x:.106 01,1,
yEWMaa'.+r�iz
_.
CONSTRUCTION FFS 101.000-418-000 $1230.00
i t ♦ t
3 { M
PLAN CHECK ISE $264.23
t+ �KtiANICALFES 101-€00-.421-000 8149.30
•°»� ;
ISL ECTRIC:.A:L. F.EL, 1.01-000.420-000 $315.04
-
r�O Fit„
PL.UI BIN 1 F i 101-000-R 19�Ci00 x02. S
STP,0140 MOTION'FRE . REMID 101-000-241-000 x+28,21
(WDING PEE 101000-423.0001 $20.00
b1
DEVELOPER IMPACT Fid $1,4113.00
ARTY' IN PUBLIC PLACRS - RIi 11701-000.235-000 t611S.27
SUB-= AL C-0C9J ENRU'Ci OX AUD PLA9 CHECK
$4,271.50
IMS PRE -PAID 'S
$0.00
a'MAL TAUT IMM DUE NUJ
$4,,27160
RECEIPT.
DATE f j
By , q✓
DATE FINALED
INSPECTOR
J
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs'
Forms & Footings
i/_
Underground Ducts
Ducts
Slab Grade
/z
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
0. K. 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
_
Final -7461 1
BLOCKWALL A PROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas TestGY�
/
Appliances
Final
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)
COMMENTS:
"
LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) C) License # Lic. ?Class,__ Ex to
r QIn
W6 40 4 B 7/31/2(
Z I— Date I O Signature of Contrac
CO 0
H C OWNER -BUILDER DECLARATION
LU w I hereby affirm under penalty of perjury that I am exempt from the Contrctor's
~ 13_ License Law for the following reason:
Z( ) 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).
co O I am exempt under Section B&P.C. for this reason
ul
cli Date Signature of Owner
O CJ
a Q WORKER'S COMPENSATION DECLARATION
o X I hereby affirm under penalty of perjury one of the following declarations
Lo H 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X w L—L compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q V ( ) I have and will maintain workers' compensation insurance, as required by
Q U QSection 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Carrier Policy No.
ao j STATE FUND 046-0007338
r0
J (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 ma so as to become subject to the
workers' compensation laws of Calif0 a, and gree that if I Id become
3 subject to tVE w rkers' compensati provisions of Secti 700 f the Labor
Code, I sh If Lyth comply wit those provisi s.
Date: �� % P"� Applicant
Warning: Failure to secure Workers ompensation coverage is unlawful nd
shall subject an employer to criminal penalties and civil fines up. to $100,00 , in
addition to the cost of compensation, damages as provided for in Section 706
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 crize repres tatives of this City to enter upon
the above-mentioned pro erty _ inspe on urposes.
• Signature (Owner/Agent Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT .0008-115 TRACT
$282,106.00 82
29457-1
JOB SIT
APN
ADDRES 49-M VISTA ESTRELLA
1
649-100-009
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TD DESERT DEVELOPMENT
SPARKS CONSTRUCTION
PO BOX 1716
79-295 RANCHO LA QUINTA DR.
LA QUINTA CA 92253
LA QUINTA
CA 92253
(760)771-1941
CBL# 2996
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD- LOT:81 PLAN:M1 - PERMIT DOES NOT INCLUDE BLOCKWALLS OR
- POOL. 75% PLAN CHECK FEE REDUCTION FOR MULTIPLE ISSUANCE OF
SAME PLAN TYPE.
CUSTOM CONSTRUCTION 3,348.00 SF . .
PORCH/PATIO 580.00 SF
GARAGE/CARPORT (SF) 13,582.80
—i1
ESTIMATED COST OF CONSTRUCTION
282,10600_"
PERMIT FEE SUAEVfARY
CONSTRUCTION FEE ' 101.000-418-000 $1,280,00
l
PLAN CHECK FEE 101-000-439=318 $164.23
F :+ I
MECHANICAL FEE 101.000.421-000 $149,50
ELECTRICAL FEE 101-000-420-000 $215.04,
_
-
PLUMBING FEE 101.000-419-000 $202.25
-�
STRONG MOTION FEE •RESID 101-000-241-000 $28.21
GRADING FEE 101-000.423-000 $20,00
DEVELOPER IMPACT FEE $1,907.00
ART IN PUBLIC PLACES - RESIL 701-000-255.000 $205.27
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,271.50
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DTTE NOW
$4,271.50
RECEIPT
DATE . rd q kv
BY
DATE FINALED
INSPECTOR
I I, V