0008-225 (SFD)U)
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LICENSED CONTRACTOR DECL4RATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
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 Exp. Date
M645 B MC A 07101/2(
Date Signature of Contractor cc 0/
J
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's'
License Law for the following reason:
( ) 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).
() 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 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I 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 INS. COMPANY O T Policy No. WDE170041400
(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
Code, /:shall forthwith comply with those provisions. f
Date: / G� cG Applicant W—- —% I
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 i<
application. G A
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 ffor, inspection purposes.
Signature (Owner/Agent)C7 V'''� 1 Date
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BUILDING PERMIT PERMIT#
DATE �• J [,�jS VALUATION ��// p;,{�, y�yy LOT ryr 0"_22-"5 TRACT
��/ � ry(pyryry �
xCsi7yA ig.90 30 2530.94
2.53894
/
JOB SITE
ADDRESS 78-807 A1ti°LI''0MWO, DP VF,
APN
-
OWNER
CONTRACTOR/DESIGNER/EN (NEER
1 n.'H0MF,9 LLC
RJT u s ra , WC.
�ho, BOY 810
1425 i'.,1''_T2J:t'�;f,2:,1 TY T)R1' E
1JAQiTft+1'.['A , C.A 02253
TJHOE JX AV2_ 5 0?4
(602)257.1656 CB" 4990
USE OF PERMIT
.ttY9ALOT 30 PLAN SA JMR.M1T nOES NOT YNCLUJI39 KLOCKWALLS OR
POOL75% CHEM VRE REDUCTION FOR. MULTIPLE E ISSUANCE OF
SAME PLAN TYPE
CUSTOM CONSTRUCTION 2004.00 5k'
rOPICHIPATIO 4' 00 Sly,
0A.12.AWC.9ARPORT (SF) 9,486,40
EST7N. A11UP !VO S"T O:8' C°ONSa'.RTTICTION
166,169-00
CONSTRUCTION FEE 101.000.418-000 $874.00
PLAN C H i:C K FEE 401-000-43.0-318 3.0-318 $1'78, 93
MECHANICAL PER 101-0004-21.000 $60,04
FA ECTftICA1.r EE 101-OOD-420-000 $137.32
PL UMBINO FEE 101.000,419.000 $186,00
STRONO MOTION FEE - RESID 101-000-241-000 $16.62
01LA.D190 FEE 101-000-423.000 $20.00
1NP+RASTRUCTUR ".E. 225-000-443-342 $1,M.00
AWf ,04 PUSL16 MACES - RESIE 701.000.255-000 6105,42
'
Y
�` Sf rr3-TC7'% COUM113CT6.. WAWDP1.M CIMCK
r3,525,29
L=13 pRCr13D MIS
$0:00
AUG 14 2000 TOTAL PKRMI Mas DIMPOW
$1_31=129
mo i✓ d�LA �42U- r+ "�
RECEIPT
DATE
fl Y ,
DAJ,� FI AL
INSPECTOR
�
,�
0461.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- . •-W
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- C-10 A<
JW
Exhaust Fans
O.K. to Wrap
-
j
F.A.U.
Compressor
,Q
VFraming ' OG v`
Insulation
QGJ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
17 T 03
Drywall - Int. Lath
L1 ri
Final
Final -Q
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
50 -Q
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
Q
Appliances
Final
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) —�}
COMMENTS:
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
78-807 BRECKENRIDGE DR
Type of Construction: VN
Owner of Building: RJT INVESTMENT INC
Tom
Building Official
Bldg. Permit No.: 0008-225
Land Use Zone: RL
Address: 1425 E. UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 2-15-01
POST IN A CONSPICUOUS PLACE