9908-187 (CP)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
i Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class ),,--'E—x
.p�ate
%Date Signature of Contractor��
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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
sale (Sec. 7044, Business & Professionals Code). . -
( ) 1, as owner of the property, am exclusively contracting with licensed
contra * ctors to construct the project (Sec. 7044, Business & Professionals
Code).
I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 37dO of the Labor Code, for the
perto ahce of the work for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which. this
permit is issued. My workers' compensation insurance carrier & policy no. 'are:
Carrier Policy No.,
STATE tl" 035_9& 112M
(This section need not be completed if the permit valuation is for $100.00 or less)
( ) I certify that in the performanceof4he ) work for which this permit is issued,
I shall not employ any persor� in'any manner so as -to'b-dbome subject to the
lree that'If I should become
workers' compensation lawsof Californi'a', and -99
.. I "!-
subject to the workers' colrnpensation provisions of Section 3700 of the Labor
,�Prm - A 1� 41.
Code, I �§Ga 1�4 i�6mply w , th thgse provisiohs,""
pate:
f
Warning: Failure to secure Workers , Compensation coverage is unlawful and
shall subject an employerto 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 pe ' rformed under or pursuant to
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
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
porrect. I agree to COMPI i 11ICity, and.State laws relating to the building
y wli�'a -
construction, and'6ereby authorize rep6e5sentaiives of this City to enter upon
�th(iabove-mentioned property for inspezTi1On1`pUrpoS,5s:
_1�/
ign
ature (Owner/Agent) -Date
BUILDING PERMIT PERMIT,4,,,.,,,
DATE?VALUATION LOT TRACT
27 � Y
B SITE 78-310 CANTLE PINE3 DRIVE,
APN
ADDRESS
I
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RJT HOMES LLC
RJT INVESTMENTS, D.X.
POBOX810
1425 E. UNIVERSITY'DRIVE
LA Q14WPA CA 1r.253
P1400OX AZ 85034
(60211,11.57-1656 CK0 40.40
USE OF PERMIT
POOL AND/URSPA
PO(A. & VA- ALARMS)BARRIMS-:31M.I. BEAN P.LA<13 XF PRE PLASTER
INS,niCT.10N.
P00t, AM/M SPA 10,000,Ri LS
'ON,
LNUMATED CCIISST OF C 041AUCTION
PERMIT FEVI SUMMARY
PI.NN L":XKFTH
C01WVf(1X11110W FIR'. 101 -000 -419 -OW S X17A0
M.RCMAWCAL TTE -- POOL 101-000-421-000 S74,00
M ECf RIC M. fVE -- FKXX, iol-W-4420-000 S45.00
PLUMBING F@E' — P00L $27.00
T'l
SUIVIWAL COMMUCT01.4 AND PIAN CHECK
$289.05
LESS ALS -PAID FEES
$0.00
TOTA14 PrMAUT FM DUE'NOIN'
RECEIPT
DATE
By
DATE
)7/(ALEYD
SPECTOR
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
ExhaustFans
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
I
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
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 Vottage Wiring
Fbdures
Main Service
Sub Panels
E)derior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)