0004-231 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
t, F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 U) W Professionals Code, and my License is in full force and effect.
C ch License # Lic. Class Exp. Date
LO
r`' JDate69 Fs FSC A.� (1 0613012(Z `� " �� `�"' Signature of Contractor,
((`D o O'
(p OWNER -BUILDER DECLARATION
J
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 1, 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). t
C'')() I am exempt under Section B&P.C. for this reason
LID
O N Date ' -Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
IL
C:) Q Z I hereby affirm under penalty of perjury one of the following declarations:
r F2 Q () 1 have and will maintain a certificate of consent to self -insure for workers'
X W 1L compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q () ( ) 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
M F- permit is issued. My workers'. compensation insurance carrier & policy no. are:
191- oo = Carrier mo, CCyI�I'A1 y OF T Policy No. WD917000013
�d
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 become subject to the
workers' compensation laws of California, and agree that if I should become
3 subject to the workers' compensation provisions of Section 3700 of the Labor
j,�ode,.1 shall forthwith comply with those provisions.
�/Date:.cr✓ Applicant 1�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
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 thisfCity to enter upon
r ,t7 above-mentioned property for. inspection purposes.
t/" g (Owner/Agent) rf,-�'r Date. >`�- c''fd
I nature�+..• �1•`
PERMIT # �t
�6 ,
f' BUILDING PERMITLUATION
-2;�1 TRACT
DATE
$214,941.0
JOB SITE
APN
�r
ADDRESS 5(l,_.520
769
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RJT Itt1WS'IME NTS, INC.
RJ'I''ERVEMAMM, INC.
1425 X 1JIMNE.OVY TDkVit
142' Xn L12 1V' 'RS_Y Y DKIVE
PROE SAG 85034
PHOEbmf AZZ 85034
y
(602)257.1656 C`MN 4990
USE OF PERMIT
M34(1120 Ia'.A2v 111 17 %I I JN(3
SPO -LOT 38 PLAN 31213; PERMIT DO&S NOT rgC:LUDP: BLOCX WALL OR
Ps3'Ol,
CUOTOM CONSTRUCTIO14 2,610,00 OF
PORCH/PAT16 140.00 SP'
CARAOSICARPORT +ASF)
:E WIM"` 7D 00S'£ 01' CQPNMUC110 Y
214,941.00
MUMMSUAWARY
CONSTRUCTION k"N?X 101.000-4.18.0100 51,04100
PLAN CHECK P'ER 101-000-439-318 $21.4.05
MECHANICAL PEI, 101.000-421-000 $iZ AO
LJ �s_y
ELECTRICAL I'ER 1101-000-420-000 $138.31
�
PLCIMBI OME 101.000.419.0100 1130.50
S'PI M40 MOTION YE9 • RES ID '101 -NO -241 -OLIO $21.49
GRADING FEE 101.000.-423-000 $20,00
DEVE1.S5PER IMPACT FEE
.ART YN PUBLIC PLACES - RESIE 702-000.235-000 WAS-
:�.i a
W&TOTAIL COWS'i:`RUC 1011 AM PLAN Ci.-:lMCK
$3,68628
I ZZ13 PRM -PAW FNS
'$0.00
"I't?IA'L 1'EMA.111 + s ME N4?1N.
6.8
a
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Ifs
A
�P
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
1.c1
Underground Ducts
Forms & Footings
Ducts
Slab Grade
—
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
3 1
Final 1 77
Final
BLOCKWALL APPROVALS
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
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
7779. GtJ
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)- OC)
COMMENTS:
TYPE OF INSPECTION DAT INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L _. NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST GAJ
HEATI NG & VENT - A/C
FIREPLACE
ROOF &=z C-101-
LOT
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH V
POOL PRE PLASTER
POO FENCE & GATE
zgMtR SEPTIC TANK
FINALS
PLUMBING
F OL GAS TEST
JOB COMPLETED L
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
CITY'OF LA QUINTA
`cab
o� BUILDING & SAFETY DEPARTMENT
OF 777-7012
r"
INSPECTION REQUI?STR'Fl�E�
777-71
SPR 2 5 2000
I
RJT HOMES LI.(t.�
Owner I QUINT
Contractor RJT INVESTMENTS, INC.
O
Permit Number 0004-231
POST ON JOB IN CONSPICUOUS PLACE
I
INSPECTOR MUST SIGN ALL'APPLICABLE SPACES
JOB ADDRESS 50-520 CYPRESS POINT DRIVE
SFD-LOT 38 PLAN 3RB; PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL.
TYPE OF INSPECTION DAT INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L _. NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST GAJ
HEATI NG & VENT - A/C
FIREPLACE
ROOF &=z C-101-
LOT
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH V
POOL PRE PLASTER
POO FENCE & GATE
zgMtR SEPTIC TANK
FINALS
PLUMBING
F OL GAS TEST
JOB COMPLETED L
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
City of La Quinta �
Building and Safety Department OFTM �v
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 comp/lance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R3
50-520 CYPRESS POINT DR
Bldg: Permit No.: 0004-231
Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENT INC.
Building Official
0
Address: 1425 E. UNIVERSITY DR
City: PHONEX AZ 85034
By: KIRK KIRKLAND
Date: 11-8-00
POST IN A CONSPICUOUS PLACE