0304-0163 (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
Z�IA 3 Signature of Cont" -actor -
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).
( ) 1, 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.
(to 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 ' '.'a!`L+ MOD Policy No. 00-160V, '747
(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 370_O..of the Labor
Code, I shall forthwith. comply witfnthose? provisions.;���
Warning: Failure to secure Workers' Co pensatibn coverage is unlawful and
shall subject an employer to criminal penaltie� and civil fines up to $100,000, in
addition to the cost of compensation, damages as,prov„ idedfor in Section 3706
of the Labor Code, interest and attorney's�fpes.
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 f
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 t8
any permit issued as a result of this applicaton agrees to,,& shall, indemni r
&hold harmless the City of La Quinta, its officers, agents and employee D
2. Any permit issued as a result of this application becomes null and void
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 g
construction, and hereby authorize representatives of this City to enter up n
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) "� Date S �" X
BUILDING PERMIT PERM'S
DATE VALUATION LOT, i7 TRACT v1hl+7�g
JOB ?�•�32�.{�1[�i'�:�t`�A �ri..�Ai�n`6
ADDRESS 4
APN
OWNER
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USE OF PERMIT
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F'4UA�4i� d 101-000.419.000
ST M,,163 R4L'`•7IGH IMP • RI SIDS 01-000-241 -000 $10,39
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MAY 27 1003
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CITY OF LA QUINTA
IE
FINANCE DE .
RECEIPT
f BY
DATE FI ALP
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fomes & Footings
Underground Plbg. Test
Ducts
Slab Grade
L -/j - 3
Return Air
Steel
y_ q-3
Combustion Air
Roof Deck
Plumbing Top Out
Exhaust Fans
O.K to Wrap
_ 3
F.A.U.
Framing
-/
Compressor
Insulation
—5-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
'— �_
BLOCKWALL APPROVALS
POOLS - SPAS
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
If
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 —'s
Encapsulation
Gas Piping
Gas Test / / .
Utility: Notice (Gas) J
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring '
Low Voltage Wiring
Fixtures
Main Service
Sub Panels i
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final f
Utility Notice (Perm)
COMMENTS:
Certificate of Occupancy
T-,mt 4 4 Qu&rQ
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 49-825 ALTHEA CT.
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3
Owner of Building: RJT HOMES LLC
1�
Building Official
Type of Construction: V -N
Building Permit No0304-163
Land Use Zone: R -L
Address: PO BOX 810
City, ST, ZIP: LA QUINTA CA 92253
By: GARY SHOWALTER
Date: 11/05/03
POST IN A CONSPICUOUS PLACE