0108-321 (3 WATER FALLS) LICENSED CONTRACTOR DECLARATION PERMIT#
I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
1-- Chapter 9 (commencing with Section 7000;//*��f Division 3 of the Business and DATE VALUATION LOTTRACT
N 21
t) Professionals Code,and my License is in fuirforce and effect. i33�T#3-.9
O j ch License#. d,. Lic.Class Exp.Date k? 1�`a.Yn'i -^ � j t3�?�ik•"'
JOB SITE APN
LLJ ADDRESS
Z r Date Signature of Contractor OWNER CONTRACTOR/DESIGNER/EN (NEER
to
O �1 _.._. ._. .,_..... OWNER-BUILDER DECLARATION
coINC. _ i `IAf1';'"�`Lv9:E; I 'In. f �'.
W W `I hereby affirm under penalty of perjury that I am exempt from the Contractor's
� splTiY , � � ,}bIT ,�
~iV5 License Law for the following reason: PHO ENIX �,r 85034 PRO � 850.34
Z ( ) 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 (602}257.1656 C.`BUI 4990
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 0k!XERALBUI LDAIG
Code).
() I am exempt under Section , B&P.C.for this reason rI:CA;f 9'4lli,&Tr.r.° I?&LL S PP,'s.APIPPIC.IM'PLANS
LO
N Date Signature of Owner
ON
a)
d Q WORKER'S COMPENSATION DECLARATION
o z 1 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' VALUATION Wk
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m QU (��**) I have and will maintain workers'compensation insurance,as required by
SI%Non 3700 of the Labor Code, for the performance of the work for which this
CL U-) H permit is issued. My workers' compensation insurance carrier & policy no. are:
't Z Carrier Policy No.
aoo Q YNS� s."'6,)�3•�'�4NY OF T W DSI7�►0 4 90 �t;+�:C IATED COST OP COWU. bUC 'ION :�#woo
Q (This section need not be completed if the permit valuation is for$100.00 or less). ' ��3!' ' '�
—� ( ) I certify that in the performance of the work for which this permit is issued, PLAN CHUM MIR 101.tyCC�_���x�I� �`¢�•4¢
I shall not employ any person in any manner so as to become subject to the Cf:DWNTICtt,IKITION FFI: I03-006-433-000 $15100
workers' compensation laws of California, and agree that if I should become EMCTIRICA,FEE--POOL 101-000.-420-000 $ 54D
subject to the workers'compensation provisions of Section 3700 of the Labor 'PLUMB-ING POOL 101-06(419-000 S27.no
Code, I shall forthwith comply with those provisions.
Date: Applicant
'—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 D d
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 k SCP�p
o 5 2001
for a permit subject to the conditions and restrictions set forth on his
application. cay do.LA
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 811YE-TOTAL Gp�ly
any permit issued as a result of this applicaton agrees to, &shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
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
TAL�� °� � '•f� �,b � '
permit, or cessation of work for 180 days will subject permit to cancellation.
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 IIIIIIIIIIIIIIIIIII IIIII 31
construction, and hereby authorize representatives of this City to enter upon IE 6
the above-mentioned property for inspection purposes. "
RECEIPT DATE, J �' BY DATALED—� INSPECTJ7R
Signature (Owner/Agent) Date z
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
rorty Wall Firewall
Exterior Lath
Drywall-Int.Lath
Final
Final POOLS - SPAS t
BLOCKWALL APPROVALS
Steel
Set Backs Electric Bond
Footings Main Drain _
Bond Beam Approval to Cover — /
Equipment Location _ G'
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: l�.J
Final
Utility Notice(Gas)
ELECTRICAL APPROVALS
Temp.Power Pole
Underground Conduit
Rough Wiring
mow Voltage Wiring
rzixtures
J in Service
,, ub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp.Use of Power
Final
Utility Notice(Perm)
City of La ' uinta
N Developers Project Approval Form.
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Three Waterfalls at Palmilla Gaurd house
79-700 Avenue 50
Applicant Contact: Chad Meyer,.RJT Homes, 760-564-6555
Application / Circulation Date: Date: 8 29/01er
Community Development Department
Christine di Iorio, Planning Manager Date
Public Works Department
Steve Speer, Senior Engineer Date