0109-026 (SFD)'04
w
0 w F
o Z
(D O O
J_
ww
f- a
U)
Z
1.0
N
Ulqt Q
a -
Z
0
Xw0 _J �
co
OV
d L 0 l¢-
�Z
ob 5
�a
Q
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
I V30102
Date , , "�� Signature of Contractor #- -..x,.14 Rte'
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 Policy No.
u 'A` Z FUND 1���1►i36. 0i
(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. } f
Date: o 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. 4t
1. Each person upon whose behalf this application is made & each person BE,
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)~ r �� •'�.*' Date
BUILDING PERMIT PERMITt/
DATE1 t VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
' iWO a
OWNER
CONTRACTOR /DESIGNER / EN (NEER
101' %a ok ;1.1.1.1c
Tib i'C WVEgaffi : l -v, me.
PO BOX 810
1425 E. UNArIUM '3'I'Y' DRIVE,
LA QtTP.lI'rV A- CA "33 2
PHORW�.X AZ 85034
( 02)253e1656 C°F-19. 4990
USE OF PERMIT
%��i IQUFsAW Y -4 J"PiC1t.fM)
SPA • WT 96 P.L&J1 PIR. PERMIT fiL)ES NOT INCLUDE t31,,C,zC'1C WALLZ,
lyOOLUSPA OR I)PUMV4VAPPR4ACH
TRACT C"i>MTj:M1C T10Y3 SF
$6�r7,00 SY
PyOR.t'A.rr#'�.rp�e'3AEC3r�e
�y� �n
0A1.Ri['1.�•5.E,�F AR.Y4i'bTi.1. �J ,M i`Sd'
(�
r
xem."..urD Go in" ar co7+1� :nt1;;3m$3I+'d
7'3,f �5t3
0CVS'1R-1JCT10H FEE 101.0-00.418.000 S91 150
Pt a'!.346' H Ibis .W8 101-000-430-418 $7M.67
MMHANIC,.AL FRIK 101-000-421-000 M50
E31 Xr r*R:IC.AI. FM 101-000-420-000 $13143
PLUMEiNO IME 101-000-419-000 $203.0
STR..0140, MOTIO'N M REBID *101-000-241-(X0 $17.76
C3 AD NO FEE 101.000.423-000 $20,00
li.l?'�,Yi!:f•�5�1�£t d1u31'.(�.iCT l°l.?3� 'i41,'�&9.(itt
.q
UD90 ••P .3
MOO
SEP 0 6 2001
LA QUINTA
ry OF
C'FINANCE DEPT.
------
RECEIPT
DATE� J° �!
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
9 7 G
Underground Ducts
Forms & Footings
/r /
�l
Ducts
Slab Grade
6 l
Return Air
Steel
Combustion Air
Roof Deck/�-l0�
f �_fiC�
Exhaust Fans
O.K. to Wrap
j `� V j,Q�
F.A.U.
Framing
Compressor
Insulation
Vents %
s Fireplace P.L.
Grills l
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
`
POOLS - SPAS
BLOCKWALL APPROVALS
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
Waste Lines
_
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
- _
Pool Cover
Sewer Connection
/%Z-
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
_
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
I
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice
50-
Certificate of Occupancy
U rY
c Building & Safety Department
9w
OFT
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the 'Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 50-075 CAMINO PRIVADO
Use classification: S.F.D. Building Permit No.: 0109z�
Occupancy Group: R-3 Type of Construction: V-N Land Use Zone: R-L
Owner of Building: RJT HOMES LLC Address: PO BOX 810
City, ST, ZIP: LA QUINTA CA 92253
By: G.SHOWALTER
Date: 11/07/02
Building Offi ' I
POST IN A CONSPICUOUS PLACE jjjj