0201-034 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and' effect.
License# Lic. Class X Exp DateCY'
o lJJB .[El itr>t'110�
Z I'*,- Date's ^ �.Ja ? Signature of Contractor!/f-�--
t00 c�rw _ t 1 4f
_J ~(O /
J U OWNER -BUILDER DECLARATION
H a I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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). ,
ce) () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
a Q - WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
LO H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W 4-- compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
M Q L)(;;,,) 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
LO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
aoo O STATEFUND)153.13906-M
J (This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to gecorne subject to the
workers' compensation laws of California, and agree/that,ifii should becom"e
subject to/the,/workers' compensationi`$rovisiondofZection 3700 of�the Labor
(
Cod e,�l shatJ/forthwith comply with those provisions.
APPlicant kit ✓ !' �n f .t _ . _.
,- .. .• ;;«:,,.��,� „�.; , _` _
t 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
iof 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 i
work is not commenced within 180 days from date of issuance of. suc
permit, or cessation of work for 180 days will subject permit to cancellation
1 certify that I have read this application and state that the above information is
correct. I agree to comply with'-allnCitq, and%State laws relating to the building
construction, and hereby authorize ere presentatives of thiw City to enter upon
the above-mentioned property for,inspection purposi
g/J Signature (Owner/Ageri''"•� "•r%•f -{•-�'••°'�"`�- Daie f �r��-'�`+✓y�i,
BUILDING PERMIT PERMIT #
DATE VALUATION LOT f,Z0ar0'� TRACT
92 298,58-1
JOB SITE
ADDRESS i^ OAi'V=01YRIVA00
APN
712-M.W 7
OWNER
CONTRACTOR/DESIGNER/EN (NEER
i23'l:' HOMES X.110
'wm wi'i''.�`i"swa'2 , E a
PODOX 810
3475 E UA.VERSAT WGIA7
LA f UTbrLA CA 91,253
PI -10 "t D1, AZ 850.14
(602)257-165e, C!BL# 4990s
USE OF PERMIT
,,, WGIZ rA1vWff ATPACI' 11
SEA -1,01.91 PLAN P1}# t�i~►tA�lT' 1�:2L�5 Y f:9''l?vCL�1i".)Y±Yid.t t�" ,
WAWA'% �t 01, Olt DRIV.EWAY APPROACH
TRACT CONSTRUCTIO)q 4894, 00 Bilk-,
FORCH/PATIO ` Wi'00 Sha
0A.RAs;rW.f4.RPORT 457,00 SFS
IWIS3AQ. : � Co-vr 033'
.w-9
MAW It Ke S�t3mm"•ii
CONSTRUCTION M 101-000-418-000 $919.50
PIAN C1_1 7.rK FEE rma
NlEl KAHICAL, FIX 101-•ta`�30-4Z1' :000 M.30
VX!"'Yliif,AJ, ti�pt?Lf i3yY-/f�J>^7�/1�-SpA"■�+4ni-pQ�g0ir0� S.�8Sk,2433
PLUMING FEE 101•'SAV0-4t9-:00D 1202.00
STRONs;51k OT1014 Mfa , RE -SAD $47.04
ORA91Q FEE220,00
T1ZP 'ZlJALR IMPACT ih
t
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0QB/y�(�y{� ]�TT /ry9���..%})� �.p/���tl 0 []'q ,ryv(' ,ryy�� q; ;� tom'[' CO
_ 4 1.4.7 *AL 1COdJ.V'�2'.1�R 414• -ION D !".1...d'1LV `4AE.MOK
Q�+] �p p ` �!
sl "7 / 5' 11.7
LESS, PIU -7 -PAID VMS
$0100
T 01F Umn. 1". ; XS DUE, NOW
0,775M,
MAY U 2 2002
3
CRYOFLAQUINTA
FINANCEDEPT
RECEIPT
BY
DATE F LED
INSPEC
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
Z.
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
9 — 2 -/- U7—
Compressor
Insulation
..-OZ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
z
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
l'a jp_ w v-� o-
— ! - G
Final
_= �v
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover a
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
COMMENTS:
F� 9,u�(`,�+
leo tT-) 7 `�Z6" C5 `
Final t
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring _ O
Low Voltage Wiring
Fixtures
Main Service
_
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final .� m
Utility Notice (Perm)
John Hardwick
RJT Homes, -LLC
79700 5& Ave
LaQuinta, CA 92253
14712 SW SCHOLLS FERRY
# 928
BEAVERTON,OR 97007
PHONE: 503-5248268
FAX: 503-213-6222
E-MAIL: mine lsonCOattbixom
RE: Structural Observation of: Ocotillo Tract 29858-1 Plan P1 Option A
Lot 92 50-155 Camino Privado
John,
A limited sample of observations were made of the above house 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, to the best of my knowledge there are no
deviations or deficiencies that have not been resolved to within reasonable compliance with
the intent of the construction documents.
Please call with any questions.
Sincerely,
AA -CJr
�'►'C
Mike Nelson, PE
Page 2 oY 2
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:
50-155 CAMINO PRIVADO, LOT 92, LA QUINTA, California
CEILINGS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21
PAIS,$ON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003