9908-086 (POOL) f
_ LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT"
• .L I hereby affirm under penalty of perjury that I am licensed under provisions of ��
W" Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION r LOT TRACT
U) S1tf)fffl.fDs!
04 W Professionals Code,and my License is in full force and effect. C (� tLKI
C) ch License# Lic.Class _. ,Exp,Date
/l__�/,� JOB SITE APN
LLJU)
P�3gG�t5 - eY�� ry �fJgyvl i'�t ADDRESS 179-370 iWAK-W
y/�. ,y'g✓ f � �� OWNER CONTRACTOR/DESIGNER/ENGINEER
ZO r- Date r" Signature of Contractor
J U CD OWNER-BUILDER DECLARATION Iver!•HL IC NIr S•IAC STT f''VES a-+MENI MS,INC.
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's PO BOX 810 1425 F. UNIVERt>Vi.'lf DRIVE,
~,a_ License Law for the following reason: 1.A Q.JINr A CA 92253 P'H(TtNIX AZ 8 5A)34
Z_ ( ) I, as owner of the property, or my employees with wages as their sole (61.)2112 7.,1656 CIM4 •9'990
compensation,will do the work,and the structure is not intended or offered for
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 POOL Ar61..3AzAR.SPA.
Code).
C'`) () I am exempt under Section B&RC.for this reason PO )L S� yP=k L�CVL,n_-Fid^/� Sf��� ����t19KI l's�:€.i+3�.I.N;06 raT
LID
N Date Signature of Owner 6'ktF:•J'LA�i['R tt i.N:' 'lit"f'9'Jf,"
O N
0)
Q WORKER'S COMPENSATION DECLARATION
CL
C:) 2 Z I hereby affirm under-penalty of perjury one of the following declarations:
U-) � O O 1 have and will maintain a certificate of consent to self-insure for workers' POOL FWD/011 SPA 10,00% 00 I—S,
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q () V I have and will maintain workers'compensation insurance,as required by
O Q Section 3700 of the Labor Code, for the performance.of the work for which this
0) Z permit is issued. My workers' compensation insurance carrier & policy no. are:
LO
Carrier Policy No.
00 to(W!
/
AT-13A QT ESt!_l04,JO "X /fxj�LQ.N"Mi I' ii #•O
K1.t�d .f.YV�'+J�afCaaSlY/
J
(This section need not be completed if the permit valuation is for$100.00 or less). �St RAIST FEE SUMMARY
( ) I certify that in the performance of the work for which this permit is'issued, PLAN G f03(,K 1,17,h 10I 76.US
I shall not employ any person in any manner so as to become subject to the r7ows1rwtC,i'tf:ip&F'L; 1AT-$ldM-418-000 17.00
workers' compensation laws of California, and agree hat-if become r r� ti
•! i*413 11ANI A;t.IT'`. --I✓CSOL Ifl,-ON-4121..#➢t)tW 5 t,itt)
3 subject to the workers'compensation provisions of'Section�3700 oft Labor
Codershal orthwith comply with ffigs2 pro�sions. b:C.XT'I:[t..AL t t _.�+t,O� 101.�y()(i-.20_otytJ
, ,~til
D"ate: ` ,.Applicant.: .-� • .�` ...� '"" `. IDI..UMk3T+3i..JF'rl;•r}►{Jc"[. 14W.000-419-4-100
VWarning: 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 ;:iM:WYt'wI.f'f;bNti"YI(LIC,IfOld AND 1y(:t1A!t.:IlE(.K. 05
& hold harmless the City of La Quinta, its officers, agents and employees. I,I1181S ITE-1-PAM))FEES MOO
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. TOTAL PERMIT FEFI 1 Wit",NoW
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 IIIIIIIIIIIIIIIIIIIIIIIII 52
construction, and hereby authonze�representatives of thislCity to enter upon r
the above-mentioned property for i'nspec ion purposes"', It IE
r,r" �� �� RECEIPT DATE BY ly.; DATE FINALED INSPECTOR
S' nature (Owner/Agent)+ "L/d/ /�� Date P
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 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 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 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)
RJT HOMES 111111111111111111111 lill 53
I
O4
CITY OF LA OUINTA
BUILDING &SAFETY DEPARTMENT
OF
777f
INSPECTION REQ51S 7t�lE ('`' 7;-
777-7153 -777-7153
Owner
RJT HOMES LLC AUG 31999
Contractor ';!"
Permit Number 9908-086
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-370 AZAHAR
POOL& SPA ONLY-ALARMS/BARRIERS
SHALL BE IN PLACE AT PRE PLASTER
TYPE OF INSPECTION DATE INSP.
FOUNDATION&SETBACK
FOO'RNG STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PPE-GUNITE.
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS&GIRDERS
ELECTRICAL GROUND WORK
OT POUR CONCRETE UNTIL ALL ABOVE WAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS&GAS TEST
HEATING&VENT-A/C
FIREPLACE
ROOF
BOND BEAM
O.K.TO WRAP
b11MRt I
—4f—
��.
GROUT O 4' ❑ 8'
FRAMING
INSULATION- E
PRE-ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE&GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
TI NO.A/C
SE NUMBERS
JOB COMPLETED 6
TEMP POWER -
ALL CONCRETE PLAT WORK SHALL. BE PLACED A
'IMNIMUM OF 2" BELOW WEEP SCREEDS.