0107-043 (RPL)R LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
,.0 hapter 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
rillflc
Datef" �� Signature of Contractgr
r�-�, g ( I
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 exclut!Vely 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
ection 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).
( ) 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 tose provisions,^
'
Date:' ? Applicant--
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crtrniKal 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 inspection purposes.
Signature (Owner/Ageni)"� Date`s .
r -
BUILDING PERMIT PERMIT#
DATE VALUATION LOT QJ�' Js� TRACT
_
45
JOB SITE: ` j
ADDRESS.,
�b,.r�4•�).N'i 10e0
APN
OWNER
CONTRACTOR/DESIGNER/EN INEER
RYTH01W, 1,14'
WT IN VE8TMR,1TV1j,'1N'C.
1'101 BOX 810
A 425 It UNI MV, ff MVE
LA Q1EWTA CA 92.233�a���
y�� � AZ 915034.
W"025,7_165.6., CIX, 49,90
USE OF PERMIT
F'OXWSP.A. AJ.AWSIBAkir'. ERS SHATX BE 114 PI.Ft=e AT PtR.&PLPi;I fM
IWOM?,C">iiON, POOL K)?t0T P!fllF%lT RNCt",C)SURF,NOT DrIC:LfJ.Ct D.
POOL ANDIOR SPA MOM" 14
f!IRD C:GVS1''C'F C0X9,F.RUMCON
JDAMOM
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AL".ir.A6KI FRE fa i T57!l r iAl��d . �i.
!'',IA14 CHECK R4 1601.000.439-318 VC06
CONSTRUCTION FRE 101-000-418-000 $t 1•r 0
MZCHAICCA1, rM9 ''- P 0 0 L '101-000-421-000 $24.00
FILRC1211RICIA11 FEE „ KTa'.rt,, 101-000-420-000 $45.00
PLUMIAWIFIF, POOL 101-000419-000 $27.00
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RECEIPT
DATEBY
DATE FINALED
INSPECTOR
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
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
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
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
ti -C U`L
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FOdures
Main Service
Sub Panels
exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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FROM :
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FAX NO. 7605642238 Jan. 24 2002 09:26AM P1
%IITY. OF LA QUINTA''"'
1 INo �& SAFETY DEPARTMENT
-7012
AN p 9 2001 oN REQUEST UNE
�.
PITY
V � 777-7153
Owner • RJT HOMES LLC
Contractor RJT EWESTMENTS INC
Permit Number 0101-018
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-650 NECTAREO
SFD-PLAN:3RA LOT:45.PERMPI' DOES NOT INCLULE
BLOClCWALLS/POOIJDRIVEWAY APPROACIL
TYPE OF INSPECTION I • DATE I INSP,
MAIN GROUND SYSTEM
GROUND PLUMBING rl
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIG ED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
_ IDT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST (72
HEATING & VENT -AIC
FIREPLACE
!fill
0 4' O S'
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE UOS BEEN SIGNED
DRYWALL INTERIOR 1 _5
EXTERIOR LATH i I A0Zs!:ol'
iiiiiciQ�II•/a�I/�
'TING -AIC ,
SE NUMBERS
JOB COMPLETED `
x
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