0010-255 (SFD)H
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LICENSED CONTRA( LA
RATION
«I hereby affirm under penalty of perjur am licensed under provisions of
Chapter 9 (commencing with Section 70 6) of Division 3 of the Business and
Professionals Code, and my'License is in full force and effect.
License # Lic. Class Exp. Date
690645 13 11111C A.
bate, ��- •, - Signature of Contractor `"r ' F �� b°�d,P •<-
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 propeety, 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 Policy No.
(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 .thos provisions. el
Date: t.J -•%� / Applicant J ` -'
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
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 rabult 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 worrWfor 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 inspeption purposes.
ignature. (Owner/Agent)
Date %'rte r wry
BUILDING PERMIT PERMIT#
DATE ' VALUATION LOT (r,��.- TRACT
Ij ]] ..pp qq ¢¢44 tM�AA 1 3 pp
1 r" ! �"Ayt �l �.'', n6�eY.�'/,i•.J�i 12 fv,J1 I
JOB SITE 1
APN
ADDRESS
'M.-874 JF;�C� r(' �fY1tiT: +w 3 i/ :
OWNER
CONTRACTOR/DESIGNER/EN INEER
R.{{7 z�yy,,�t7WIME 04C..
Ra�°�:NEEryr�gy,ry�r�y3��y+,I
«,
.1425 H, ��L' IVERpSi� 7Y �dS31�L>
�•..+y��>7 a►
14.26 .5°n W9:V•C4J.'iL&?:F�LS 1 l+•it,SjVi:'r
P.Ly.MaiW AZ 8503.
PHOS„ M AZ 85034
(602)M-1-16,56 MIA- 499
USE OF PERMIT
OMME FA L Y LA M3:,]it G
STD. - LOT I;k PLJA N +1n.PMMI T UOQ 140T INCLUDE BLOCK
W14,k.,1'>11001-t'SPA OR APPRryAf; H ],+irtVEW-AX. *75% PLAN C119CK ME
R?DUCTX0W FOR 114111!,NCV, 4P' :lA.MR PL A *N TYPE
CU21TOM tnf3"MUC?'TON 2,004.00 ar
,9?t.)]:i,i'l1PATIO 43,00 S1"
484,011 OF
CONSTRUCTIUM YEW 101 -000,41 8 -OW "S974.00
PLAN +: HECK, ME 1014*0-44391 219
1,fEC NICALME 101-tiL'ig42 l -000 $60,00
FIXC>1RIf;d53. P&W. 1L11'-000-420-000 $113.32
i"];v71r(LBING rim, 101.OfJt 41.9'x000 $166,00
� ,,t
S`fi4•f: NO MO 1OM 1FK • .R'MID 101,-000-241-000 $16.62
a31 APINO FEY, 101.000.4423.030 $20,00
1�lar'✓��4,�'3:�d�� )l�!1='.�4CT E�Zi'• $1,9is`7.00
`^'' t.>. :� .
SCTRIOTASL C0.1�3' UCTION A14D PLANT CII)ECK.
LE33 Me -PAW F' f
$0,00
• r > a
.. SFBAvJcAf .I.yB'rMI .�C.L'rl�..13 .T.l1iE NOW
RECEIPT
DATE. +
BY
TE FAD
INSPECTOR
X
t
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
Framing'�
Insulation _sem _
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
',, Wall Insulation
Condensate Lines
rty Wall Firewall
t, erior Lath
Drywall - Int. Lath _ �}
Final
Final
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
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
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
Fir jI ,
Utility Notice (Perm)
COMMENTS:
a
,
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
ollowing.
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R3
78-874 BRECKENRIDGE DR
Bldg. Permit No.: 0010-255
Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC
Building Official
Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 6-28-01
POST IN A CONSPICUOUS PLACE