0101-021 (SFD)t 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
Date.' "! Signature of Contractor
f•
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):
( ) 1, 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.
(This section need not be completed if the permit valuation is for.$100.00 or less).
() 1 -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 pro isio,9• s,.I
Date: f �- Applicant st, (mss 11
17
Warning: Failure to secure Workers' Compensatiofi 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,.inderpnify
& 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) _ 1 1 0, �(• .4i VV Date
BUILDING PERMIT , PERMIT# r
///
DATE / VALUATION LOT TRACT
y ,
JOB SITE
ADDRESS
APN
^ �`
OWNER
CONTRACTOR /EN 1NEER�y
`/
k,1T HOMES i..pl.�+\.+
y�/yDESIGNER
ki 1 � 3.94E rt,,o" d..iP.IR.'A''41.�, Y.4 c. -
FQ DaYX 8I Q
142.5 X IrtNlV�,i���i'�Y DRI'M
;i<AQi37( 2..mA. CA 922+3
101110" AZ Ier0:4
(602)257-1656 C". UI, 499"
USE OF PERMIT
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FA.777Wi,•�i'�isr.4Siitla E.l� F -S NOT 18,��N4!DE
PLAN CHR/Cly. FEE
RMIAI TION FORL IMS PsNCZ LSV S&ME PLAN °l`V-11u r
CUSTOM VONSTRi CT)ON W3.09 SF
c i i I 'r'e"1'10 1341.10 sr
QARh0PJ;A1F.4 0.RT ( H=80
T'11a..c�{.I�"5.": tI .+� t". I TTAdMARY
CONSTRUCTION 3' Y, I01-000.418rt000 $1,;9G91m
PLA14 CHECK 117% 101•-000-439-31 3' $226.5Q
MXC',3WlCAd,4s 1 1311 ��Jt3pa4X 4.>i1i>CIG!3.
ZI.YXTRICAL. PRY, 10140 00-420-000 33�t4.3�
I'LLf.4+,3 THO"F2 101.000.419-000 fi411i•�
s ' O�ar, t 140110N PUZ o RRMrQ 101-DOD—U1-000
ORAWNG AgE 101e000-423.000 R ,dia
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ART" WPUBLIC PI.,AC:09 - I1FLSIC' MAJI
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9
REQEIPT�lDATE1•'
BY
DATE FINALED
INSPECTOR
• is '� }
/' i�. , • f',S�'
SL rrY.
INSPECTION RECORD
�r
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
Exhaust Fans
O.K. to Wrap
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
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
Z_�. �j (
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection��
d�
Pool Cover
Encapsulation
Gas Piping
Gas Test
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
UtiFur-y Notice (Perm)
COMMENTS:
-
FROM FAX NO. 7605642238 Dec. E3 2001 11:48AM P1
o d �
2
Y OF LA QUINTA
c6yG & SAFETY DEPARTMENT
�} AN 0 9 20011777-7012
LA 7 7153 REQUEST LINE
Owner RJT DOMES LLC
Contractor RJT INVESTMENTS INC
Permit Number 0101-021
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
Job ADDRESS 50-730 NECTA17EO
SFD-PILAN13RA LOT;49-PERMIT DOES NOT. INCLUDE
BLOCKWALLS/POOL/DRIVEWA'Y APPROACH.
TYPE OF INSPECTION DATE I P.
FOUNDATION & SETBACK %-
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL LL ABOVE HA BEEN SIGNED
CONCRETE SLAB -
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
40T POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
;t ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF (1
BOND BEAM
O.K. TO WRAP - a
GROUT �] 4' O 8'
FRAMING
INSULATION r if
PRE-ROOF
COVER NO WORK UNTIL ABOVE HAS. BE N SIGNED
DRYWALL INTERIOR
EXTERIOR LATH _ p
POOL PRE PLASTER
FENCE & GATE
JEWtj SEPTIC TANK
FINALS
ELECTRICAL p
PLUMBING
FINAL GAS TEST
0'—*,TING-A/C,
µ
jSE NUMBERS
JOB COMPLETED ,
TEMP POWER
ABOVE APPROVALS P0. NOT INCLUDE RIGHT TO