9908-087 (POOL) t9, ILICESEDpONTRACTOR,DECLARATION �p �i BUILDING PERMIT PERMI`#
1i herebyaffirm under penaltyof perjury
that-I am licensed underi rovisions of
1�- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATEVALUATION LOT TRACT
ci W Professionals Code,and my License is in full force and effect. Cl�11611•�`� w4y4Ch�C�
r. O C7 License# Lic.Class*""'"% Exp.Date -
Q�E tS � r 0613t�()t ADDRESS 79-360 t��'2a URLLJ APN
Z � ate Signature of Contractor
/�+. .:._:--." OWNER CONTRACTOR/DESIGNER/ENGINEER
O
w!`P
t` I.— CID OWNER-BUILDER DECLARATION °:T iC1 3 ;•ry '��T llc!+ I4�y'1.�NTTSS
T.I ENIC.
J U "L�!
� aW PO B?:'►'.810' 1425 K M11W?i1;S.iI'�.
I hereby affirm under penalty of perjury that I am exempt from the Contractor's .
U) License Law for the following reason: f,tldJlN" A C y51• !PHOENIX fid. 5(l3td
Z_ ( )• 1, as owner of the property, or my employees with wages as their sole (002Y'257-'1A.M C CLO 4.990
compensation,will do the work,and the structure is not intended or offered for
sale,(Sec.7044,Business&Professionals Code). USE OF PERMIT
( J,, I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals t ➢1-AN ?ft� t�1�.1�
Code).
c'`) () I am exempt under Section B&P.C.for this reason POOL&SPA C)N V-AJAR+�ES19�1,id.�*.�Ai�31-WA,AE 1N►'�itt�C"`6•AN
u7
cv Date Signature of Owner PJ''''L�,S'TM 1NSK VMJ14
O CV
a)
Q WORKER'S COMPENSATION DECLARATION
oQ I hereby affirm under penalty of perjury one of the following declarations:
LO H O O 1 have and will maintain a certificate of consent to self-insure for,workers' 170M AN Q.3, A ii3,t70(1.00 LS
X W compensation, as provided for by Section'3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued..
m Q U ( ) 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
tl LO Z permit is issued. My workers'compensation insurance carrier & policy no. are:
Carrier Policy No: q � wg 01 "'T y 40=100 000 Vj 5'9,3,i 2aV eCryNyAYAwD i[ ryN s1 y �l � i4 �y6AK1
J
(This section need not be completed if the permit valuation is for$100.00_or less). Y°Eu�'%W A�F KIWI`�T�€1��:��1�V..
( ) I certify that in the performance of the work for which this permit is issued, VL AN Cf 1Pd"K FIX 101-000-4341-:18 $76.05
I shall not employ any person in any manner so as to become subject to the F'<�1\t�:1ii(iF"Pf�1N 't?!? p(y!_f►RffwAYR.�1(A1 $ff7Ftf1
workers' compensation laws of Californialand agree-that if I should become
subject to the workers'compensation visions of Section 3700 of the Labor aM1,l:Qf"€r�'�frt raT f1 �-.[C/f�s j�3A^,r+ff X31 i�2(� u�,o.fKT
' C�o7de, I shall f rth lith comply withth e�provisio ���� 1' .f�a'r iciC lel:FEE-�lsGYt)i. iU.-.000-420-000 $i .iitl
Date: shall f.
Applicant Z«^) ��., f�l.Ut�It3i2 F ril; •-.S�(��lT Elul_000-4t;4Lkl`00 1132"••.4itf
1111ill 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 AND!'tX C;(�;
& hold harmless the City of La Quinta, its officers, agents and employees. PRT,? T,VD FEES StD
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. lCV17,1S. m % ff+ i 9+£k.:S&30F rfC;1�aV
1 certify that I have read this application and state that the above information is �4
•
correcV I agree to comply with all City, and State laws relating to the building I IIII II VIII I I III I IIII 48
construction, and hereby authorize represeH—tatives of this City to enter upon � IE
th above mentioned°p`r`operty for<'nspection purposes: s'
RECEIPT DATE By / DATE FINALED INSPECTOR
Date
Signature--(Owner/Agent) < v
•
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 }
I
BLOCKWALL APPROVALS steel
Set Backs Electric Bond i-
Footings Main Drain I
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 I
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 (/v
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)
04/30/2002 09:09 7605646505_
' ` _ I IIIIIII VIII III VIII IIII 50 1
IE
CY �
CITY OF LA QUINTA
BUILDING &SAFETY DEPARTMENT
F 1 777-7012
f
�.. INSPEariomf T�UIVIT
owner— RJT HOMES LLC AUG 131999
Contractor Ril
Permit Number
9908-087 • - • +^ '�
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS ' 79-360 AZAHAR •
POOL/SPA ONLY,ALARMS/BARREERS
SHALL BE IN AT PRE-PLASTER
TYPE OF.INSPECTION DATE INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE r
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNEO
CONCRETE SLAB
JOISTS&GIRQFRS
ELECTRICAL GROUND WORK
' IOT POUR CONCi ETE UNTIL ALL ABOVE HAS BEEN SIGNED
!ROUGH
UGH ELECTRIC
UGH PLUMBING
GAS 8 CTAS TEST
HEATING&VENT-A/C
FIREPLACE
ROOF
BOND BEAM
O.K.TO WRAP
GROUT o 4' O 8'
FRAMING
INSULATION
PRE-ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE A GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
TING-A/C
"'TSE NUMBERS
JOB COMPLETED �L
TEMP POWER
ALL CONCRETE FIAT.WCIRK rSHALL BE PLACED A
MINIMUM OF 2- BELOW WEEP.3CREEDS: