0010-252 (SFD)t� LICENSED CONTRACTOR DECLARATION
I hereby affirm`,under'penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect. ,
p ch License # Lic. Class Exp. Date '
�QLO j, p
690645 DEMA
ZO oDatefs ?'9»t'�} Signature of Contractor, Al
I-- (D OWNER -BUILDER DECLARATION'
W W t` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ License Law for the following reason:
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
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
M() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
OC
Q WORKER'S COMPENSATION DECLARATION
o Cc I hereby affirm under penalty of perjury one of the following declarations:
HO () 1 have and will maintain a certificate of consent to self -insure for workers'
O J J compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
M ()
Q () Mfr)' I have and will maintain workers' compensation insurance, as required by
O U : Section 3700 of the Labor Code, for the performance of the work for which this
ZLO permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
w Z) h�i i��'s,'l i FUND
J (This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
3 Code, I shall forthwith comply with those provisions.,
Date 'r. -'- r'F.a Applicant
Warning: Failure to secure WorkersCompensation 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
& 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
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fTo4 inspection purposes.
VSignature (Owner/Agent) •`` fosDate���`";7
BUILDING PERMIT PERMIT#
DATE , VALUATION LOT 0010,;252 TRACT
JOB SITEi j APN
ADDRESS
OWNER CONTRACTOR/DESIGNER/EN INFER
142-5 &1 TfW, *RWYY ;l?Fwt'tr.R
l. -11S AF:1w11.X
USE OF PERMIT
RX1,'MrEMMM"o, WC
1425 BE, UIRV1D?UT"X'.M'4
AZ 85034 PMENDC, AZ 66034,
(602>257--1656 C.'�V; 49910
SRFV - LOT 4, PLAN IRR, P'EF.bll A° DOES' NOT l?`Er;:1..UDY, BLOCK
IVALLMOOIAK A OR APPROACH DRIVEWAY,
i�OS�t;" rJf.Eal+�l'[&3 90,00 Sp
131ARAOT. 4".00 :4V
XOTM, MID Cour OF C011MIlue
c oN
240,4MM
Ct?A49TRUC 1014FEE
101 -000-418-000
$921.00
,
PIA14 CH1'ICK F Ink
101-000.439-318
SZ,3,24
MEOW410AL FEE
1121-000421.000
34.0.30
&i,.C'F'liIQ-AL ,fs
P`9,IUMBANO FRE.
1433 nCOn•419�C�®3
S;;�S. l
t ; `t +'.:
ST7rEClNi3MevYF.ION irkE- ID
101-060-241-000
(WAVING FEE
101.000.47.1.000
V0.00
0XII'i�-ri"(. TAL C;t1=...t)'f~:`.f�.C;!14 .P 14D PLAN CR_?
LESS PRE-FAMFEW
RECEIPT DATEP BY DATE FINALED INSPECTOR
50100
a
INSPECTION RECORD
°OPERATION j
DATE INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs-�
_
Underground Ducts
Forms & Footings��_
Slab Grade
Steel
_
_
`�
Ducts
Return Air
Combustion Air
Roof Deck
Encapsulation
Exhaust Fans
O.K. to Wrap
(J
F.A.U.
Framing
_
-161 (
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
-% 1 lal,
POOLS - SPAS
BLOCKWALL APPROVALS steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
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
Annliannpc
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice
COMMENTS:
{
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CITY OF LA QUINTA
/BUILDING & SAFETY DEPARTMENT
f °F 777-7012
INSPECTION REQUEST LINE
777.7153 p''D .
Owner RJT BIOMES. LLC 1p
Contractor
Permit Number 0010-252;ITY U' LIQ►
POST ON JOB IN CONSPICUOUS PLACE...
...
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDREM-845 CASTLE PINES DRIVE
SFD - LOT 21 PLAN ERB - PERMIT DOES
NOT INCLUDE BLOCK WALL/POOL/OR
APPROACH DR13MWAV
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE . +.
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS I'
ELECTRICAL GROUND WORK
t,_ • OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC t
ROUGH PLUMBING I
'ROUGH GAS & GAS TEST
i
HEATING & VENT • A/C j
FIREPLACE
BOND
GROUT 0 4' 0 8'
FRAMING
COVER NO WORK
'ALL INTERIOR
BEEN SIGNED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TI IGAI Ohl I ITU ITiFa no rv-r:I IP11 RI III nINr;
Ed WUge :0T TOOE 0Z iof SOS9b9S09Z : 'ON Xdd
X
S9WOH-1fd : WONA
POOL PRE PLASTER
L FENCE & GATE
R SEPTIC TANK
i
ELECTRICAL
PLUMBING
Ff AL GAS TEST
NG - A/C
E NUMBERS•
JOB COMPLETED
:S
TEMP POWER
BEEN SIGNED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TI IGAI Ohl I ITU ITiFa no rv-r:I IP11 RI III nINr;
Ed WUge :0T TOOE 0Z iof SOS9b9S09Z : 'ON Xdd
X
S9WOH-1fd : WONA
Certificate of Occupancy
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:
Use Classification: SFD
Occupancy Group: R3
78-845 CASTLE PINES DRIVE
Type of Construction:
Owner of Building: RJT INVESTMENT INC
Building Official
Bldg. Permit No.: 0010-252.
Land Use Zone: RL
Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 7-13-01
POST IN A CONSPICUOUS PLACE