0008-127 (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 xp Date
Date ,y t?t / '' Signature of Contractor
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 fhe 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:
CarrierPolicy .
STATS fi't'J}3t� No046-04A%/38
(This section need not 6e completed if the permit valuation is for $100.00 or less):
O 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 agree that if 1, Should become
subject to the �orkets' compensation proves ions of Section 3?00 of'the' Labor
Code, I shall forthwlth'comply"with those provisions. /ter
Date: : , r ; �,.; Applicant 4 ✓r 1
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 authorEbyepresentatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)i,. r �° 1 Date',
BUILDING PERMIT PERMIT"
>1.2i
DATE VALUATION ��ss7� qq qq/,yy /�yy,qq LOT, �q TRACT /�[�pp ! 1
jr Mt,I l3d•C'JsGAIl�al!tf 94 2245 1 - 3.
JOB SITE ' -
ADDRESS 49-75 VISTAEM. ' X d A
APN
6494W -M
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Td3:17W.`! x7EWLi3PMENi'
SPARKS cONSmuconm
F0 BOX 1716
79.2 9 55 F.MC:1A QUI NTADPL
U.QLTi,Nr-A CA. 92253
LAQUINTA CSA. 92253
(760)771.1941 6B1..* 2996
USE OF PERMIT
SM. LOT:04' PLAN:MIR =• PERMIT DOES NOT INCLUDE BL(IC.tCWALLS OR.
POOL, 16%PW4 (Al9CY FEL RPRDUCOON FOP, MUI,I1PIA ISSUANCE OF
SAME PLAN TYPK
CUOT M CONSTRUCTION 3,348.00 OF
Pl3kcH/PATIC) 5&8,06 Sl
0A RAGI /C,ARPORT (SY) I,1:I,,82,N
1TS.CMATi) COS"' OF C>s XM11173170N
282,106.401
PRZiViff FEE GUA0WtY
< `k
CO NSTRUCtION FEZ 101 -000.41 &S 000 $1280,00
r
PLAN CHECK I+'I'.'E 101.0011439.318 $?44.23
MECHANICAT,, FEE 101.0011.421-:000 $140.34
LIi.,ECTRICAL ME 701-000-420000 $215.04
PL>UMBINNO FEES 101.000.419000 ' $262.25
iT1LciNC € aglow FEE - RYS1A ! 0t .000-241-000
€ W)INO ME 101.000 4V-000 gX00
DEVELOPER IMPACT FEE$1,90700 ',
T)
ART ix Pi1nic Pi.ACis Rim 1111 �04}t3rw-000 $205..7
»� �
SUB— TCYiAI'-. CO2 "ftit=09 AND JPi'. kX C?MGY.4,2
i 1.? 0
LESS PRE -PAM FAV
$0100
RECEIPT
DATE i
BY
V i
DATE FINALED
INSPECTOR
' jr
a;✓aa .�-.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
� 6J
Underground Ducts
Ducts
Slab Grade
_Z
Return Air
Steel
_Y
Combustion Air
Roof Deck
_
Exhaust Fans
O.K to Wrap
_ _ _ !
_
F.A.U.
Framing
Compressor
Insulation
_
_ 1L
/
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
_l!_�
POOLS -SPAS
BLOCKWALL 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
/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
���
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
j rl
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)
/