0008-222 (SFD)LICENSED CONTRACTOR DECLARATION PERMIT#
U„ I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
1— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 0"-T2•7
DA �''"� VALUATION LOT TRACT
W Professionals Code, and my License is in full force and effect. (� $1 j� �g t p %6 2,5399.4
O _.,,m License # Lic. Class Exp. Date
� CJ,t,� JOB S TE APN
1,� LU 6901545 B HTC A, f/ 07101/2( ADDRESS 7"39 } JCA C_KFA4RY0Gt!.' IDRiW.
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Z r— Dater 1.L. Z l^'' Signature of Contractor ^! "' -,"� OWNER CONTRACTOR / DESIGNER / ENGINEER
CD 0 ,
J U C) OWNER-BUILDER DECLARATION Pir 11011M T.LC R,1'1'INC.
UJ W I hereby affirm under penalty of perjury that I am exempt from the Contractor's POBOX-81.0 1425.E, UXfM43Y1T DR1V9,
~ U) License Law for the following reason: LA QUDN'`1.'A CA 97253 PH0mgw AZ 85034.
Z_ ( ) I, as owner of the property, or my employees with wages as their sole (607)25.1.1656 CBUI 4990
compensation, will do the work, and the structure is not intended or offered for
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 SWIAE FAWLY DWEL.tNO
Code). .1 ,Z SFTD-LOT 26 PLAld 5B -PERMIT DOES NOT INCLUDE BLOC:K"WA AZ OR
( ) I am exempt under Section B&P.C. for this reason
"' POOL, 504 t9L�A.N CHECK IRR UNCTION FOR MliL 'PiX,103U#`�)�it�E OF
Date Signature of Owner
ZSAME PLAN TYPZ
WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm; under penalty of perjury one of the following declarations:
LO p () I have an'd will maintain a certificate of consent to self-insure for workers' CUSTOM CONSTRUCTION Z004.00 OF
• X Lu compensation, asnprovided for by Section 3700 of the Labor Code, for the e�131 Citi#P41'1'IO a 43.00 5F
O J Q performance of the work for which this permit is issued. CAR.�LCJF./CARPORT (SF) 4,486.40
C0 Q () ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
't Z Carrier, Policy No.
C
00 5 INS. COMPANY OFT C�Iak:190Q419t19 F.Sag'LLiWti I+ 9 C:()ST CDS' C oNg.i',RU(TnON 166-169.90
J (This section need not be completed if the permit valuation is for $100.00 or less). CONSTRUCTION F1 1014000-413-000 WA,011
() I certify that in the performance of the work for which this permit is issued, FLAN CHF.CIC �.K� 101-CiC�i-X39-31 �' X1%8.93
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 MECHANICAL FF._ 101.000.421.000 $60.00
subject to the workers' compensation provisions of Section 3700 of the Labor RLWTRICAL PFLe 101.000-420-000 $137.3
Code, I shall forthwith comply with those,provisions. PLUMBING Fly 101.000.4.19-000 3166,00
Date: - ! ti- ,,'s7 Applicant `jf • � �. %''� STRCYNO MOTION FEE - RWID 1 -000.241-000 $16.62
Warning: Failure to secure Workers' Compensation coverage is unlawful and CtRAD NO FEF } 101,�00(�423-000 $20,00
shall subject an employer to criminal penalties and civil fines up to $100,000, in INFRASTRUCTURF, FEL+ 2254000-441.342 $),907.00
addition to the cost compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. �`' s'^ A,RT 1N PUBUC PLACES - RESIE 701.000.255.000 $165.42+•
Y i
IMPORTANT Application is hereby made to the Director of Building and Safety t
for a permit subject to the conditions and restrictions set forth on his
application. V.
1. Each person upon whose behalf this application is made & each person at 4' «. r «
31U iy`ltiaT ON001 �t1�1.1.C' 0 A:tr1.�31?3:11P1' CUE�,`1C: $3,525.29
whose request and for whose benefit work is performed under or pursuant to 1
any permit issued as a result ofthis applicaton agrees to, & shall, indemnify '' �UG '� $0.00
& 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{t•.. <� '-+'t"l�'AL P �l'Frn-S D-CYC : >'1(?1Rr $3:52529
work is not commenced within 180 days from, date of issuance of such w Ur
permit, or cessation of work for 180 days will subj9ct 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 F
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertyforinspection purposes.
RECEIPT DATE BY D E F AL INSPECTOR
"..r/
Signature (Owner/Agent/ + AW- . `--- Dateie "T
INSPECTION RECORD
OPERATION
. DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
CUnderground
Ducts
Forms & Footings
Ducts
Slab Grade
raj'
Return Air
Steel
Combustion Air
Roof Deck
/.- - G
Exhaust Fans
OX to Wrap
dY.G -
F.A.U.
Framing
CtJ
Compressor
Insulation
Z. 4Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
l' . 6- 00
Final . p
Final 2 -Z_�-v
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines=
j �l�
_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
. C�
Pool Cover
Sewer Connection
_�
I
Encapsulation -
Gas Piping
Gas Test
Appliances
Final
Final Z.2 - Q(
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 r?(
Utility Notice (Perm) 322 0
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
78-839 BRECKENRIDGE DR
Bldg. Permit No.: 0008-222
Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENT, INC
-I-et., 1-k
Building Official
Address: 1425 E. UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 2-26-01
POST IN A CONSPICUOUS PLACE