0101-014 (SFD)LICENSED CONTRACTOR DECLARATION
I,heceby 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
bate, Signature of Contractor ` Fi `+"� t ! `''�✓"
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.
( ) 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.
SATE FUM) 1533906-0
(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
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, indemnity
& 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 p'
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) { ��''../ c " =�^ Date "
BUILDING PERMIT PERMTJt
DATE VALUATION LOT 0101-()}4 TRACT
!
I V1144MAG 41 2R44?
JOB SITE
ADDRESS
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50,65V P f°,e�'�.. d.Cb1�.1�~0
0 d 6r�WiL�„wi,HY�i
OWNER
CONTRACTOR / DESIGNER / EN (NEER
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'PO T.+'4llii 8)0
D'�r.ure5. '& V.S'Od�YS' ^'a.�4�T DR,F.YL:. .
L.&q 'A, CA 92253
AMT� x A7, 85034
USE OF PERMIT
A'2.C't'4.YT...rY:r1.'�1T'si.rJCD9YIM:134C'w.i'
.YY0J11.u'tX?J1 SA's'#"Wa rPtLWIT DOES NOT INCLUDE
3>..L^)�" f:�a � I IPE 112 k��6A►,> �R' APPROAC:HMSOOM, ,!* CRECK Fe;
PXA)IJC3'R)N FOR, MU1.3xFU ISS'Z1.> RCE OF :111Vq PLA3M 'i'YPZ
CUBTOth cor."11TRUCTION 21571.00 OF
PORC f AIJA °t` 0 203.00 y.1<
' ;L'.+371G`4:iA Li i'w'!d' CiJF 0Y M.MUkM1iJ'Ov YdV.F1
214=.40
io.1°'000-418-00 SJp04F.i10
WTICHANIC,A.d.,, RE '101.000.4.21.000 'l3 f�9d3
}+➢..,�it"8R'fr~�t.,kre'aF 101-i3i.2iJ-420-000
PLtlta9UNG PEE 101-000-419-000 $190150•
STl?ONC MC'E DTI Or FEE - X .3530 101 -0010-241-000 $21.49
rt1R,ANNO 1T11': S it l �t3 Gold N.t1t3f� 5 �.
DEVELOPER IMPACT FIEF. VX01.00
ART 1Ai'ZIFiL1C1 �'1�b�o;4 • Wr t' i.i�f�C)����•"�fKEO
-
EE .TO.X.'0Wb,FCrt'R'l�`aANDPLAN COMM
$ 3 603.44 .44
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S3,693M
'RECEIPT
DATE j x�
ByJj ',
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
BLOCKWALL APPROVALS
POOLS. - SPAS k
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 T
Water Piping Z - �_� ( G�
Ak
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection eZ " / Y
Gas Piping
Pool Cover
Encapsulation
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:
05/30/2002 06:07 7605646505 RJT HOMES
O
j ITY OF LA QUINTA
DING & SAFETY DEPARTMENT
M °r N 777-7012
� `
ITION REQUEST LINE
.01` y V r LA � 777-7153
Owner R.JT HOMES LLC
Contractor RJT INVESTMENTS INC
Permit Number 0.101-014
POST ON JQB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
x`50=690_NECTA2E0
JOB ADDRESS';
SFA-PLAN.2B LO :47- ERMIT DOES NOT INCLUDE
BLOCKWALLS/POOL/DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK ' •`f
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
10T POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUM91
ROUGH GA GAS TEST
HEATING & V T - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP t-
GROUT 0 4' 0 8'
FRAMING
INSULATION
PRE-ROOF .
COVER NO WORK UNTIL ABOVF_ HAS BEEN SIGNED
pRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POi`3L FENCE & @ATE ,
EW R SEPTIC TANK
FINALS
ELECTRICAL ` U
PLUMBING
FINAL GAS TEST
' - NT1 NG - A/C'
SE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON.UTILITIES OR OCCUPY BUILDING
PAGE 01