0008-220 (SFD)LICENSED CONTRACTOR DECLARATION
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
6906+55 }2 MC A X07101/2(
DateSignature of Contractorta
,
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 Ili$ ("OMPAPNY OF T Policy No. WDE17MI900
(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 those;provisions.
Dater -G=!!1.., <, Applicants`yui
Warning: Failure to secure Workers' Comp sation 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 for inspection purposes.
Signature (Owner/Agent) 1 Pik • � � � Date �/ ��-• ��
PERMIT PERMIT#��
jjjjjjUILDING
2ZO
DAT, �y�,V%�LUATION LOT ' TRACT
22 2538914
JOB SITE 1
ADDRESS 7S-971 BICMCKMMUR DME
APN
OWNER
CONTRACTOR INFER
R3t ROAM LTX
RJp1 EMUM- , I c .
P03 WA SIO
1425 __ 1JMVJ M,, TDR
LA.CjUWTA C'P, 922S3
PZ✓Yowor AZ 85034
(602)7.57.1656 CMU, 4990
USE OF PERMIT r +
SWQLE RAWLY D'Wk:I..s LING
SFU>1.AT 22 PLAN 5B -PERMIT DOVS NUF INCLUDE HLOM-WALLS OR
POOL' 534 PLAN CHECK FEE RKDUCTION FOR MUIMPLEISSUANCE 0317
UAMP, PLA34 TYPE
(.".VOTOM CONOTRUCTIO14 4004,09 BY
VORCH/PATIO 49.00 SIP
11AQP/C,tt RPORT (SY) 9,436.40
ES'Tils'IXIZD CONT Ole C.°O•[RM.Ui.'1.TON
1CaGbiEr�w�i►
�yy� �' p+q;{•p
F D..L4.6Y,9d a. F! A!.i`u i.741Pii��.116.1.F�
CONIRS TRUCTION IZE 1.01.0100.418-000 S3',4,90
PLAN CHECK ME 101-OW-43CJ-318 $179.93
MECHANICAL IEE 101.300.421.000 $600
ELKCT RICAL .PEE 101-010-420-000 $1:17.32
Pl tilw9llINO FEE 101.000-419-000 $166.00
STRONG NOTION 1rEZ - 9=10 101-000-241-000 $16.63
ORADINO FM 101.000.423-000 M.00
TNFRASTRUCTURE FEE 22S-f40t 44.3-342 $1,907.00
PART IN PURLIQ ;p LAAW - RIM 01.000-255-000 $105,42
1 ;
n-J0ZJ1SC1PN8TRtTC:`d"x0N A14D TIL AN CHECK
$3,525.29
IS03 PRR1 PAID F=
$0.00
TOTA"T MI-w—rM6 ME -flow
RECEIPT
DATE
BY
DATE NA D
INSPECTOR
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
Exhaust Fans
O.K. to Wrap 46 1 z I WSF.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
Final
Final
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines �ii� ��/
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
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
78-871 BRECKENRIDGE DR
Type of Construction: VN
Owner of Building: RJT INVESTMENTS INC
Building Official
Bldg. Permit No.: 0008-220
Land Use Zone: RL
Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 6-1-01
POST IN A CONSPICUOUS PLACE