9910-0138 (SFD) `t01
LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
I hereby affirm under penalty of perjury that I am licensed under provisions of '� fl-7$
F-� A Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION LOT TRACT
C14 � Professionals Code,and m License is in full force and effect. 49 ,fs7`?7
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License# Lic.Class Exp.Date
O. JOB SITE'
W ✓6�G4J B _ i'1tt,•j30f.W ADDRESS 7hkfEd•A 19-440 AAPN
0 Z I-- /ate Z, Signature of Contractor OWNER CONTRACTOR/DESIGNER/ENGINEER
O T'r H0vi l3^c e 0 MCI w�T 11.,bra�a»tme'I's wc—.
OWNER-BUILDER DECLARATION 4.. " ° °t s^'��• Y 4' ..+,""
W W I hereby affirm under penalty of perjury that.I Arn exempt from the Contractor's P. ANE
PO�.8II) W2 .VNIVE'�,` �F Y$�
~
C/) License Law for the following*reason: LA R LUR4d1`�r, LA r.2' L PHOENIXr,41 "U�d
Z_ ( ) I, as owner of the property, or my employees with wages as their sole [ }25�-3.C`iC Ci3LW 4. 90
compensation,will do the work, and the structure is not intended or offered for
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT -
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals .Rl�fae' •!3�1,
Code). r
c`� () I am exempt under Section B&P.C.for this reason SfiD-LOT 5,PLAN 1.00 I (Aa y Nl,jTk INC'ieJ3�� .�1�.e;+1'rK.IVAS�,G��
N t�O01-75%#iF(afl1C V10)..4 ON P AN CHF�itr",9.Fixe l��f^10MU1.'I'tf~'X ISSUA.tu.11,
Date Signature of Owner v
O 017 3AAAR.F�..AN T Y P E,
Q WORKER'S COMPENSATION DECLARATION
°p Q Z- wing declarations:
I hereby affirm under penalty of perjury one of the following
p ( ) 1 have and will maintain a.certificate of consent to self insure for workers' I:"ta 7'iiN•1(;t}i `�`! I% .l�i4 2,�7 ANI S1
X W � compensation, as provided for by Section 3700 of the Labor Code, for the iT;.?RC1+73 AT.10 ;!12,60 aF
OJ Q performance of the work for which this permit is issued. t i�1£tAillt;Ai.`+,F'Cl:[1'f' fi1+.+6.fidj ; '
m Q U (�) 1 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
CL LO H permit is issued. My workers' compensation insurance carrier & policy no. are:
N11 Z Carver I's s7 l� p/ Policy No: �q a TV} �ry ��g �{ ♦+� y g}�yT{�(�gp� 1{�y y y yrs
.� /5 'INS.CONWY014 Y 0.('�•. y�1'.M�.�,L^i�'1/�.hf C.�111� E91 INAL A bL3)•�°..i,9A�f IA O.!', OIN 911IR�.C f1 IION
V
VAIMARY
J (This section need not be completed if the permit valuation is for$100.00 or less). °RNU F U
( ) I certify that in the performance of,the work.for which this permit is issued, a: i39"Ik$IL"i'1CJf� /t:Fs l.fl'fx+!3D-X11 -fit C1 E,t}f4.tYt►
I shall not employ any person in any manner so as to become subject to the > #-AN t'1iFtIX F1 1101 4991439-31 R,f
workers' compensation laws of California, and agree that if I should become ASC eT��PJIC;�1 PUS U.1_Oi)0J2x-Ot'�L' $It<e t}f
subject to the workers'compensation provisions of.Section 3700 of the Labor
Coy1� I shall+forthwith comply with those provisio si^ 1.
^Er' tta g ,p j1.'t11�-. 1y_(}( �1, •q7
tg te' •• r':�%'`� {Applicant— �� 1'I t�i�hRa3f3C}tri 1fi:l-t+(3t1�+1i �4)Qt1
f..-' <rbc"•.3 ?-!k'JPJ Ztti.+S"3
� Warning: Failure to secure Workers'Compensation coverage is unlawful and 147:_()N(a 1110TKYN YFF-TTF1g1f RM
shall subject an employer to criminal penalties and civil fines up to$100,000,'in c.ajt;l:m,,iC_F i<'W 1.�9t;i�;>tt.46.i�tCTO $ .Od!
addition to the cost of compensation,damages as provided for in Section 3706 C9lV1,t�.ke12 IWAp::f Fa.
of the Labor Code,interest and attorney's fees. AA,M E'M.i{."..1'l.!!CES-1dESID"7dl.l-r�Q1i?-i
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 (jB-'I'(.YT'A;_.rry0`i!;)8'TR4,YC If0N1 ANDKAX CH.13 ,K 99 ?rcif
& hold harmless he.City of.La Quinta, its officers, agents and employees. LESS a F-rlID VTS
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 suchr �,, a
,ps
permit, or cessation of work for 180 days will subject permit to cancellation. I'� $IQ1R�% �'�- 6.�II-E9+, i4 71 �o
IIIIIII VIIII I VIII IIII
F 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 74
construction, and hereby authorize representatives of this City to enter upon IE
the above-mentioned property for inspec'fion purposes. — _- -
,� RECEIPT DATE BY DATE FINALED INSPECTOR
�,Slgnature (Owner/Agent) °' Date ` '` "�'e'
ti
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 :Z-`2- GC/ 14Z-0 Exhaust Fans
O.K.to Wrap � � F.A.U.
Framing v Compressor
Insulation G Vents
Fireplace P.L. Grills
Fireplace T.O. Fans&Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath -
Drywall-Int.Lath _ _ cA
Final
Final 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 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
,ffewer onnection - — Encapsulation
-gel-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)
of Occu anc X(Certificate -
p� G
City of La Quinta
Building. and Safety Department
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: 79-440 AZAHAR
Use Classification: SFD Bldg. Permit No.: 9910-138
Occupancy Group: R3 Type of Construction: VN . Land Use Zone: RL
Owner of Building: RJT HOMES LLC Address: 1425 E. UNIVERSITY DRIVE
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 2-7-01
Building Official
POST IN A CONSPICUOUS PLACE