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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
11 111C A 0010,1
Dale '�' Signature of Contractor �7
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.
Vy) 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 3TAT3 FUND Policy No. 00906.01
(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 provisio df -Sec ' rt' 3700 of the Labor
Code, I sh�11 forthwith comply with those provisi.o s.
Date: `I/"�'+> Applicant
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. 9
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, indemnir
& 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 voi6 i
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 cancellati tn.
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 inspectiofi'purposes.
Signature (Owner/Agent) !".-�'� Date✓" '
BUILDING PERMIT PERMIT#
DATE VALUATION S179X1.S0 LOT 100 TRACT
--t - -- - C ,c?.
JOB SITE
ADDRESS 50-0.50 CAMN10 �=�''r�VAD0
APN 77"M M
OWNER
CONTRACTOR / DESIGNER / EN (NEER
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).425n MUSIE R "Yr►?ttt}.9
C& 92AS3
(6102)2S7-1656 U STA 4990
USE OFPERMIT
8D401,H IPJ.NJT Y A YA.C.Tn4d
SPA. • WT 100 PlJk.1 PI,A., PF',RMIT 17D S'JOT IVt 1..Jf)X''8LDCK
WA1.L.% fg001, OR DRIVi:WAY APPROACH
TRACT C(YNSTRUIC"nN 21894.00 V
PORC,,HIPATIO 9917.00 SP
(MRA41MARPORT 07,00 :3F
.Lt`S;1'11.A' ' (MYT OF Cf. KS TU"UM00'
11WW.50
MUM.T ,!E'R SOMMAY -
C01418 RUC' ION PIS 101.000.418.000 3919.0
PL,6 to CHECIrl,-719 101-000-439-318
MEC 13.MITCAL YEE 101.000.4-21-000
Z1:&A.%'R1l:,t Lire , :01-000-426-0000
Pw,tsltii`B1WO "Y_ 101.000-419-000 $.200.00
S T h'.CJi1• O W'ITION 1WN • REWD. 101-000-241.01X) $117.9.
ORADl3 O RX, 101-000.42,3-1100 $0.00
.DE EB OPER IMPACT 11%' $2,40),.00
Im -. ` C141S`A' L7f Tt1?St W 1'��A± CME :k#
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CI O LAQUINTA
FINANCE DEPT:
RECEIPT
DATE
BY I � �.
DATE FIND
INSPEC R
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 3 - .Z
Exhaust Fans
O.K to Wrap _ -Z
F.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
D- 3 -cam
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection Q
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 2,
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) -
COMMENTS: /0,;ez; 1,JW,1/ Bl":23-oz
Page 1 of 1
YekI
BEAVERTON, OR 97007
PHONE: 503-524-8268
FAX: 503-213-6222
E-KAOO_: uroubm iM.c=
John Hardwick
RJT Homes, LLC
79700 50"' Ave
LaQuinta, CA 92253
,7
RE: Structural Observation of: Phase 213 /
Lot 99, Lot 100, & Lot 101
John,
Sample observations were made of the above houses to ascertain whether the intent of the
construction documents is being followed. Of the structural items that remain uncovered and
easily observable, it appears that, in general, there is reasonable compliance with the intent of
the construction documents with no unresolved deficiencies.
Please call with any questions.
Sincerely, y - 627�
X
a "MG
R
AA san sl9 CN1�
OF CALF
Mike Nelson, PE
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
CEILINGS:
TYPE:BATTS
WALLS:
TYPE : BATTS
50-050 CAMINO PRIVADO, LOT 100, LA QUINTA, CALIFORNIA
MANUFACTURER:CERTAINTEED
MANUFACTURER:CERTAINTEED
THICKNESS: R-38
THICKNESS: R-21
ZNtELO T , CT . RJT HO S LICENSE #
TITLE:S��L�p�l
B
N SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003