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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 '
u�liV S B iiiC.A W30r20i
Date ��Signature of Contractor
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. .
(U,,,l 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. sS
1 vs.��Ji tuv°a'e✓i Intiii,�C�Si+W,1411"O
(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. hall f7liwith comply with those pro siogsr�
Date:, /� I , r Applicant—
Warning:
pplicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made'to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work -for 180 days will.subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspe tion .urposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#�l!' t �
DATE VALUATION SZ_f4941.88) LOT 45 TRACT ?.53W)-4
JOB SITE
ADDRESS :W0.6lX1 (IMI RFS1% POOL IrT DRI A:
OWNER
CONTRACTOR, / DESIGNER / ENGINEERR
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IUT i!'.e��Tll11111 :,V Jl''
b423.E. O'NATR$iZ f TD.RAT
1425 E. UiNIVF SITS..' DRIVE
PHOENIX Ai 85034
P1401±NIX AL 8503.4
(602)257-16.56 CRIA 4440
USE OF PERMIT
S'1140LF. RAMIj V i �NELLiPltls
5170-LOT45 Pa.Ad4 3- t 0t;S NOT INCLUDE POOL V.R 1;51.1>I.'K WALLS. 154111,
PLAN CIiiSC K fr.F!I;1Ui1_X :1 ON itQX IWLIL'1.VLE 1,15SUANC f CSN SAAB b' P Aly
TV K.'.
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d�G,%'C'y 0'h9 �USIR
PERiVM TF I&F,SUMMARY
C0NS']'.P 1C: LQN YJAJ, 101-M -4 W -i) O SI,0420,t
PL A'N 4rN i � (`k 1 7 10 f-(��(lNui� d�E(� •li�fll�R a?fled. tirt�
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14v�'CL W141l.(I{�L FCIT4 J!1 ^V U11 A'r,. i-�14�{i
ELL-WiiUC;AL 171EL 101-' W_0_420.000 S�15t3.i3I
PLO.Mf IND FEE* I014fL'U-419-wo $1 K0. ii)
S'rR Wn Ar1t'>'f'10W RT. - 114178)1T) I flf -f fiEl.' 4141f1f1 $' J 49
0R1►IJING i7M. - 101.000---000 Sw0 t10
.Di::Y' s 0DLit IMPACT S 1,fiii�.U!f
AWf tN PUBLIC PLACES 14148 70$-000-255-000 $2217.35
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.1.:111"3 d PR'EIP ID HIS
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RECEIPT
DATE
BYI f
6 1 �-"
DATE FI ED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
6 uJ
Underground Ducts
Forms & Footings
Gd
Ducts
Slab Grade
L -
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
– U- opi
Compressor
m �`
Insulation
lj
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
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
Gtr
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
. 6/(
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) – 0cj ldgIA—
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
50-660 CYPRESS POINT DR
Type of Construction: VN
Owner of Building: RJT INVESTMENT INC
Building Official
Bldg. Permit No.: 0003-092
Land Use Zone: RL
Address: 1425 E. UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 2-08-01
POST IN A CONSPICUOUS PLACE