0008-230 (SFD)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
1C14 U) ---
Professionals Code, and my License is in full force and effect.
OLicense # Lic. Class Exp. Date
CY 11r,
r;Lu690645 13 UIC A 07/01 /2Z
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~ Z id
Date' 114-6' ' Signature of Contractor ' )"1 u°L'M1f
CD0pl� � t
J U OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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
LO
O N Date ' Signature of Owner •=
rn
Z WORKER'S COMPENSATION DECLARATION
CIL
C) Q Z I hereby affirm under penalty of perjury one of the following declarations:
Lo F2 O () 1 have and will maintain a certificate of consent to self insure for workers'
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 () ( ) I have and will maintain workers' compensation insurance, as required by
b U Q Section 3700 of the Labor Code, for the performance of the work for which this
Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
q14- Z
oo Carrier INV, COMPANY OFT Policy No. $ 13170041400
C)
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
Code, I shall forthwith comply with these provisions.,
Date: '/ G/ "i C• Applicant rl t" t F
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 K
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 i
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 for inspection purposes.
Signature (Owner/Agent), - -• • 4 � E • �3� Date
PERMIT#
BUILDING PERMIT
DA� /)/VALUATION LOT �� TRACT
.d-2�
' 8
S7f►.,'�,r�4Q.3U 253891
JOB SITE
ADDRESS 71154W JY1MC1MN. ,)GX DRIVE
APN
- w
I
OWNER
CONTRACTOR / DESIGNER / EN (NEER
F_rr igow.� s Li'..0
R.rr wFarmiN'I a" lac.
PO BOY., 810
1425 L 'UNliT.1y"MTT DPJ\fL
LkQ 11TfA CA. 92253
P14.0..MT-'. .AZ 135034
(602>257.1656 CBLO 4990
USE OF PERMIT
Std; -LOT 28 PIAN 4A-,P)':i%i/ IT DOES NOT INCLUDE BLOCK'WALL OR.
P010103% PLAN CHECK FEE REDUCTION FOR MULTIPLE ISSUANCE OF
SAME PI..A14 TYPE
CUSTOM CONSTRUCTION 1,984.00 SF
PO;RCWPA#'IO WOO SP
0AF.AWCARPOR.T (SF) j 9,466.80
:9STftd'A KD C09r OF CON'Sl.RUCrION
1,65,044',h.0
CONSTRUCTION FEE 101.000.418.000 5870.50
PLAN C'HVCK MW 101-000-439-318 $I77,70
MF.CHANICA,L FRX 101.000.421.000 $60.00
ELECTRICAL r"_ 101-000-420-000 $136.60
PL UMBINO F{EE 101-000«419.000 $1157.00
STPt NO MOTION PEI; - MSID 101-000-241-000 $16.50
ORAL)ii OKE 101.000.423.000 $20.00
INFRASTRUCTURE FEE 225.000-443.3,12 $1,907.00
ART IN KJOLIC PLACES - I ESK 701.000.255-000 $162.61
ME -TO AL COl\TM UC°.C'ION AND PLAkT CHECX
$3,501.91
1=3 PRE -PAID PEES
$0.00
AUG 14 2D90 aXAL POW.rYns DUER Mow
$3,50791
IT'Y 01-" L�� i i�3 �•
?t
RECEIPT
DATE
BVT
IN L
INSPECTOR
0
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— , a3
Underground Ducts
Forms 8 Footings
_
z
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans f _
—
O.K. to Wrapi
_CCS
F.A.U. (
Framing
-, QQ
Compressor
Insulation
-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
OAw
Drywall - Int. Lath
00
Final Q
Final -G
BLOCKWALL APPROVALS
POOLS -SPAS
steel
Set Backs
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
I
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
O 1
(sC
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
. 2mp. Use of Power
Final
Utility Notice (Perm) - QWc
COMMENTS:
Certificate of Occupancy
City of La Quinta
Building and Safety Department Of�t°`'
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:
78-823 BRECKENRIDGE DR
Use Classification: SFD Bldg. Permit No.: 0008-230
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENT, INC
Tom-► /4-11.0
Building Official
Address: 1425 E. UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 2-26-01
POST IN A CONSPICUOUS PLACE