0111-233 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I tl 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 moo Exp. Date
Da�te
674 .{
lurfi
Date P1' P'!,r Signature of Contractor
OWN ER-BUI LDER'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). ./ .
() 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'♦�� +� [ry y� Polic No.
(This section need not be 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, and agree that if 1 -should become
subject to the -workers' compensati, n provisions of Section `37 0 of the Labor
'Code, I shall forthwith comply with t ose provisions.
Date r > J:,, % Applicant u P
Warning: Failure to secure Workers' Compensation coverage°is-u6
wfuland
shall subject an employer to criminal penalties and civil fines up to $100,00,0, 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 forwhosebenefit work is performed under or pursuant:to
any permit issued as a rest -!t of this applicaton agrees to, & shall, indemn
& hold harmless the City of La Quinta, its officers, agents and employe n
2. Any permit issued as a result of this application becomes null and voi
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for, 180 days will subject permit to cancellati
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 buildi ig
construction, and hereby authorize representatives of this City to enter upn
the above-mentioned propertyafor,inspe°ction purposes, c
✓r lo .
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE j VALUATION LOT 0"'1_2"3 TRACT
]j g 66
JOB SITE '
ADDRESS ..3.35 vym xsaw'W rLA
APN
'649-100-M,7
OWNER s-.
CONTRACTOR / DESIGNER / EN (NEER
7� i"+ "fit C 17Fw i 1r"� C23�1 33'
9'.iaARKS C0H.WR'U<.1X0,lti!
P() ,B(y7;17) 6
7.9-7,93 AN01110 Lk Q11DRA 1,.R.:
CMS- :9225. _..
- ;iAQ(TMOA CA 922:53
(760)771-13 1 X14 2996,
USE OF PERMIT
fiFD _ .I, OI' 66 PLAN W. P1+'6t',i'a11't DOES 1400 INC.`.L_ IVE BLOCK idfAU-1,
P004 SRA OR 6Rr4FWAZYAPPR0A0H
CUBTOM C O1+6OTRUCy1'ION WIN 3F
PVVCAD'ple ifRA.'E,'Kr) 267.003V
-
C
•a7iill�..r`22�+�ii ��✓.4�+.E6 R5t.�7i.'.�. tb �"t.lYv'� �+l' ..
i
•
/ .. COST., V9'V.i'067 Z'F•ulsA.Ao
'•�+-�/�
Rv6L7go5li�.�X)
1,, y y,{� q'���ep'
Iw`C.►'k S RUCTION .W: 101-000-4,18-000 $ 1,06uo
101.000-439-.311; dY7.90
+
MWCf WNICCAL nZ 161.000.42,1-000 Q165,06
l, t lr. 1G?3�l tblJ dE-Clllli) k6e,ti8
4 Lk71 1111 3C18� - I t11 -000 -41.9 -WO
111-000-2.41 X000
ORA LITHO RX 101.000.423.000 926.00
E&VELOPER. :11t PACT Ig8Z $1,907.OL'
AW. 1.111UP'.LiC PLACES Rux'�1C 270-000-445-000 $52.13
'rumprA4V14A,,'r isi:rS DIMHOW O
UNJ9 I h Ja�6v
DEC, U b 2001
CI'Y0FL.A000NPA
J
t`
RECEIPT
DATE t "
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
-OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
y —/se— Z .�_
Underground Ducts
Forms & Footings
y —/�— 2
Ducts
Slab Grade
_
a —Z
Return Air
`
Steel
Combustion Air
Roof Deck.
—J/
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
,p
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
_
Fans & Controls
Party Wall Insulation
_
Condensate Lines
Party Wall Firewall
_
Exterior Lath
.
Drywall Int. Lath
V
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steer
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
Waste Lines'
m,
Electric Final
Heater Final
Heater
Water Piping
���
2
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans_
Sewer Lateral
_
�p�
O.K. for Finish Plaster
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
_per
Fixtures —
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
D�
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 HIC 07/31/2(
Date 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 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:
STATE FUND Policy No. 046-0007338
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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) Date
BUILDING PERMIT PERMIT#
0111-233
DATE VALUATION LOT TRACT
5220,852A0 66 29457-2
JOB SITE
APN
ADDRESS 49-335 VLSTA ES 1ZI L
649-100-007
OWNER
CONTRACTOR /.DESIGNER / EN (NEER
TD DESERT DEVELOPMENT
SPARKS CONSTRUCTION
PO BOX 1716
79-295 RANCHO LA QUINTA DR,
LA QUINTA CA 92253
LA QUTNTA CA 92253 - -
(760)771-1941 CBIif 2996
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD - LOT 66 PLAN El. PERMIT DOES NOT INCLUDE BLOCK WALLS,
P004 SPA OR DRIVEWAY APPROACH
CUSTOM CONSTRUCTION $635.00 SF
PORCH/PATIO 267.00 SF
GARAGEICARPORT 614,00 SF
ESTIIVIATED COST OF CONSTRUCTION_
220,852.00
PERMIT FEE SUbR14ARY
CONSTRUCTION FEE 101-000-418.000 (1,063.00
PLAN CHECK FEE 101-000-439-318 $217.90
MECHANICAL FEE 101-000-421-000 $105,00
ELECTRICAL FEE 101-000-420-000 $162.01
PLUMBING FEE 101-000-419-000 $179,25
STRONO MOTION FEE - RESID 101-000-241-000 $22.09
GRADING FEE 101.000-423-000 $20,00
DEVELOPER IMPACT FEE $1,907.00
ART M PUBLIC PLACES - RESIL 270-000-445-000 $52,13
- SUB -TOTAL CONSTRUCTION AND PLAN CHECK.
$3,728.38
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
S3,728—
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR