0101-020 (SFD)LICENSED CONTRACTOR DECLARATION
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
rE� Je��4 1C3.WC A;I A 0613012.
Date - %_ !f Signature of Contractor' 1 f'"; j1/
VY.
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 'p'roperty, AM exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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.
V rg KIM) ! SQ A-pfj
(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.
Date:. Applicant
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 '•5
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
constrL;tion, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. n
Signature (Owner/Agent) +! `.r �r f �` r Date'LJ -, J
BUILDING PERMIT PERMT#
DATE/ VALUATION LOT Z��.,IQ TRACT
1 ., /, 48 VA47
/
JOB SITE " /r
APN
ADDRESS
tW 17.1;1 "NaTIARK0
772.060-0
OWNER
CONTRACTOR / DESIGNER / EN (NEER
INC.
PO :k%OX 810
1425 E. 'UNIV M -WY' 1:?:R.PITt
;ice i"3,•f3INTA CA 92253
'SI-XIMA ac AZ 85034
('602Y2,5` -1656 C EUP 4990
USE OF PERMIT
rt D-PLAM 3t l,Cf1`y1tl PERY1 NT F9O.M'.t OT IMCs1..UDZ
13t�C?L T�'�/;A'.G►,�fi�'asa3.a'�g:R 1�! �!�'d3.'�' �1'R�'f6b.C`.1t .°��'ep��td tv.���I* 'I?Ill� .
)12t)L'tC','7°10H $0R, 2sRU1311Y.•'Fc.•S !$8U[JWC H, OF SAM1 +. Pi.AN TYPE,
CUSTOM :;Ma:C3a.1.101101 �� 13.QO STS`
IO - 138.00 SY
/PORCHIP.A:
`..tkli�Da�S.YiYfti�B'ad' �iS.Iji �U3'� � d,,J$�,11V
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'P:ls, �:1�!isrr FEE ?;d�wxTA
001'iS'TI1.Ut;i'iON 1 101 ��JY3t,1r�•1,:� OtSEB 1a113Q:;tt►
PLA14 CHWIK Mf 14:1.000-439-318
Ml* CHANIt;AL FHE 101-1000-471.000 S9 100
}r.UC'9'Rf.CAtl RT, 101-000 4ZO-0 0 $1,9.22
}?l,.ixM'E1'M-0 PEE 10] -WO -419-000 MOM
STRO Ct ;MC7't IGH FEE . RESID 101-000-241-000 $33-77
01,.A Dft-TO FEt 101,.000-423.000 MAO
x".t1M E -10P ?P-041'AFCT PTX $1,9i3'T ao
ARTIN PUBLIC PLA.CJI I - R15ME 701 000.253-00 VA.37
4.
LESS PRE'41AID -EIMS
S0100
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RECEIPT?DATE
/f fiF
BY y�
DATE FINALED
INSPECTOR }
g
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
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
Heater Final
Water Piping L i (
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _ _
Sewer Connecfion ��' ` 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
Utility Notice (Perm)
COMMENTS:
-
Y
FROM
y.,
9'.
i
FAX NO. 7605642238 Dec. 14 2001 09:19AM P1
Y OF LA OUINTA
• `�' & SAFETY DEPARTMENT j
oF'1 777-7012
JAN 0 gt1SWTIO REQUEST LINE
�� Y Vt' LA UU�7.7153
Owner
RJT HOMES LLC
Contractor RJT INVESTMENTS INC c
Permit Number 0101-020
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-710 NECTAREO
5FD-PLAN:3RB LOT:48-PERMIT DOES NOT INCLUDE
BLOCKWALLS/POOUDRIVEWAY APPROACH.
4
TYPE OF INSPECTION DATE INSP;
FOUNDATION & SETBACK ( .
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING U . 4.
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS 13EEN SIGNED
CONCRETE SLAB Kvi
JOISTS 3 GIRDERS
ELECTRICAL GROUNDWORK
40T POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST' l
HEATING & VENT A/C
FIREPLACE
ROOF 111,23
BOND BEAM
O.K. TO WRAP
GROUT O 4' • ❑ 8' 7-75 - 7
FRAMING — ( -
INSULATION / CJ
PRE -R QO.F
COVER NO WORK UNTIL A OVf, HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
OEWE04 SEPTIC TANK /
FI
FINAL GAS TEST - /y. . C, / d
' NTI NG - A/C
JSE NUMBERS /
JOB COMPLETED
TEMP POWER
AM^%/C AoOM^%)AI Q f%^ &JnT lkirll 1 IrIC Ol/24JT T(1