9910-137 (SFD) LICENSEDCONTRACTOR DECLARATION f {
I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT PERMI,a
16— ` ,}Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE /4 ' VALUATION � � a �{K,, E3 LOT �} TRACT J,tt 17
14 W Professionals Code,and my License is in full force and effect. . .
� ' License# Lic.Class � Exp.Date 2 t
O W /ate
�IasM130t Nd ADDRESS 79-450 S�w��AU APN ")�► tl .
i
ZO I-- �`�' Signature of Contractor _ �� OWNER CONTRACTOR/DESIGNER/ENGINEER
OWNER-BUILDER DECLARATION ,3`:l%.'"i i i i��:. L fLI V-C' 0i3'+Ai.k i��..� INC.
LU aI hereby affirm under penalty of perjury that ham exempt from the Contractor's P.0&Ot',910 14351L UN IVERS11Y WIVE
U). License Law for the following reason: I<rtaQCJlNIA, (11A. 97253 P14C.`a'iLNIX KZ 0034
Z_ ( ) I, as owner of the property, or my employees with wages as their.sole ttfyf3'„ ���.•a�i4(j .'. �,}f •S•?P
compensation,will do the work,and the structure.is not intended or offered for r IIIIIIIIIIIII IIIIIIIIIIII 77—`—
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner,of the.property, am exclusively contracting with licensed ;
contractors to construct the project (Sec. 7044, Business & Professionals 5.1N9:i1.E FAMILY ME I.,1,.NG IE
co Code).
() I am exempt under Section , B&P.C.for this reason M U-A.0 �k,9�1,:.r1cd'2Td.A�RMI T i�ar^:A Nt I Cfi�wLlif"��i13 4a�"J �rA1,5.c"h�Z.
N Date Signature of Owner
0 rn UziNi}3 t�t.f� f'6' Pia.
�.Q "WORKER'S COMPENSATION DECLARATION
p CcI hereby affirm under penalty of perjury one of the following 'declarations:
Lo < O ( ) I have,and will maintain a certificate of consent to self-insure for workers' Y,`7,00'S ' {
X W LL compensation,:as,provided for by Section 3700"of the.Labo_r Code, for•the ;'� ntaa3lC'.i�,i'ia? MOM�y�
� Q performance of the work for which this permit is issued. Cio`�l2SxF+Jd)r�l�I'f"z3t,1' ii.�$dtjtf y
Q CJ (g I have and will maintain workers'compensation insurance,as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
LZ permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier y �h I Policy No. ayt/777� �D(�,/ �f'' Yy� sGt��I'`�+�� �cd���aa y yy }�� p}8 prytCr��� g8y�q}�t�
07 = YANS.fw'•�i��'LPANT ar Vj:� l' bb'l1R.11�b7MI11 0 6�-511r'++.i,�'�.f,8 ED C..4/�aP•�. 'illi' '�1..>.✓4-ST.Y0.a:jt,�t.YtIN 2 14�eDww.AQ
a
Q (This section need not.be completed if the permit valuation is for$100.00 or less). VERAQ7 FEE SUMMARY
J ( ) I certify that in the performance of the work for which this permit is issued, OUN3TRUC.tFICON FEE €01-M-1.418-OW
I shall not employ any person in any manner so as to become subject to the fl,AN OtTil"(1K,T-11s -101-M11011-49-31 8 T)2!4;41
workers compensation laws of California, and agree that if I should become
sub et0 the workers'compensation provisions-of Section 3700 of the Labor 1V :1� b C' ;"FTE 1t?.I`Q�1'}.�:$1.M
3 CAe, l shall forthwith comply with those provisions:, #:Iit It ("�+::A�3:S
ate: /I ' ;" "� Applicant -•'� S�L'IJ71?F3I Wo fes? 7pq_ + 1�►d'tQ13ttiC�. a
Warning: Failure to secure Workers'Compensation coverage is unlawful and S1. 4�:if 'dI?T.FR 1014VIN-241-MID
shall subject an employer to criminal penalties and civil fines up to$100,000,in `GRay.)ING FTs le 101-000.4 23-000 s'r.Yj.tli3
addition to the cost of compensation,damages as provided for in Section 3706 DSVI"LOV'Rk 11�lf ACT Flim
of the Labor Code,interest and attorney's fees. f1)ft'd'FN f'UBt,Rt;to. f:`h 'sLi:10:1. bl2Q-X .q)f}(}. $1,9%.1.
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 St WK-TI'A1,C-QNS' RITfiRON�,'�;D PT,,{NY t;;13E(;K 53,9$3:44
& hold harmless the City of La Quinta, its officers, agents and employees. LESS i IFFES
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. TMfed.V"''+fr NIF FEWS f➢U;�.l�V". W ss,9'I'+D.4-4
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 r-
the above mentioned property for inspectlon,pt rposes.
BY AT FI ALED INSPECTOR
/� /
S" ignature (Owner/Agent) iJ `^ Date ''''"' ry DATE
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms&Footings Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
O.K.to Wrap �" _ F.A.U.
Framing ��/ Compressor
Insulation _ c{f Vents
Fireplace P.L. Grills
Fireplace T.O. Fans&Controls
Party Wail Insulation Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall-Int.Lath
Final
Final POOLS - SPAS
BLOCKWALL APPROVALS steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Pibg.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 O.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)
=ROM RJT—HOMES FAX NO. 7605646505 Mar. 29. 2001 12:38PM P1 j
l;OU k7A,CA 97.253 . tl
CELLULAR! (760)
PHONE: (760) 564-6555
CITY OF LA OUINTA FAX: (760) 564-6505
r�
BUILDING &SAFETY DEPARTMENT j
777-7012 1
i INSPECTION REQUEST LINE
777-7153
RJ'T HOMES
Owner LLC RJT HOMES,.LLC
Contractor Rj'INVESTMENT
Permit Number 99IU-137 MAILING: P.O. Box 810
POST ON JOB IN CON 0 LADUIk7A,CAUfORNaA 92253 4•
INSPECTOR MUST SIGN At�M ABLE SPACES
JOB ADDRESS
79-450 AZAEAR
SFD-LOT 4,PLAN 2R. PERMIT DOES NOT MATT NEVINS
INCLUDE BLOCK WALL OR POOL, GENERAL SUPERINTENDENT
TYPE OF INSPECTION DATE INSP.
FOUNDATION&SETBACK
� u
FOOTING STEEL 1 7dt
MAIN GROUND SYSTEM i
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB ZZ
JOISTS&GIRDERS
ELECTRICAL GROUND WORK
G.,10T POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS&GAS TEST -
HEATING&VENT-A/C
FIREPLACE
ROOF _ 7 Exi
BOND BEAM
O.K. TO WRAP - LU
GROUT 0 40 a'
FRAMING
INSULATION
PRE-ROOF
ilk
VFR F�Pt Mr( fill 41n:T14 a sc'v� :_:�.. ~cc. ^IMO
n';rvVALL INTERNR)
EXTERIOR LATH /L
POOL PRE PLASTER
POA FENCE&GATE
ER SEPTIC TANK Z.2
FINALS 9
ELECTRICAL LU
PLUMBING
FINAL GAS TEST cs ai
,.
NG•A/C
SE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
i e of Occu,
pancyCert�f cat
City of La Quinta
Building and Safety Department
�MoF
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. . For the following:
BUILDING ADDRESS: 79-450 AZAHAR
Use Classification: SFD Bldg. Permit No.: 9910-137
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENT INC Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 3-29-01
Building Official
POST IN A CONSPICUOUS PLACE