0101-011 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that •1 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 f' Signature of Contractor--f� J J �� ,
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 ezclusiVely coWddting 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.
STATE FUND 13�3�fs6-4if
(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: + i'` 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, 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.
•s.
Signature (Owner/Agent)- " • ^•� l�•- Date •--- , -
v .
BUILDING PERMIT PERMT# t
VALUATION LOT �1;'Qi.l.; TRACT/9'�i•��� .r.. .
/J
4w� M f r
131 /i.S �. i .. �8 06 .A. 41.210 43 s•aat"v
J SITE'
APN-_-
ADDRESS NW -610 A111/AmaE0
'TrI " - 0X 4
OWNER
CONTRACTOR DESIGNER ENGINEER
:h'„1 t°
:RJT 114F111.WITM,1J 41C.
PO BOX 610
14 Z5 L U1< IW RW. Y1?+1rIVE
LA QT)111eTA CA 9 5:.
PHUERCK AZ 95034
(602)2-57-1656 C' 1.1 4990
USE OF PERMIT
s
SM PLAtite:J.¢"W 1.: T43 P1?jfiVIT DOES 1407' 114CLlfi: Z
I
CUSTOM t:`C:NS TR,UC:" tION Z4770.00 ;SF
C�R4iIt1�ATjf3 112.00 �F
39.717MURD Cow, or C,fSNSIRUCi7100
2,06,171-10
i7,0143'i`l?Uti~` ION FU 101.000.4.18.000 V,014.00
pl..s4 H CHITZK ]PEZ 101-000-439-,316 19_45.:0
3A1L ;r1�t11t" 1.Rh 101--000-4-21-000 Slag.00
�q�EY "1 $156.41
tYfb y9.,8I p'Ty/l�ti"3�gtxL.A1, Y01-pdi�00-4(20-C/C�0
r!.9`Ia�Il7.%)-Y�?`h:0 EPICS 101.v�i'+ 0-41 F-000 $180.50
ST.Rt A40 ;MOTXONI FBE R R? ID 101-000-241-000 $20.62
C1iiiADT4f0 FUJI 111 -OUCH -423a000 $26,00
DII:'4t'E•1,.(91?ER IMPACT FZZ $.'9111.00
ART IN PUBLIC PLAC - HZIL 701 -000 -235 -MU
Y.
1
1 116111 G:f3Af�l"�t.UC:'�.'1O �1' O PLAN C�'ICK
$4,234.52
PRE -PAW RIMO
$0.00
jg.19A1�P'ram, F.Cti.it;IS UE Po
44�:�a3^4 rsy tb
No, .
RECEIPT r
DATE /
BY 'i'
DATE FINALED
INSPECTOR '
�/
!1
INSPECTION RECORD .
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
Set Backs �. 2� v 1 GCs
MECHANICAL APPROVALS
Underground Ducts
Forms &Footings (� t
Slab Grade
Ducts
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
Final
'Final
POOLS -SPAS'
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I 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
Appliances
Final
COMMENTS:
_
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
mp. Use of Power
FRnal
Utility Notice (Perm)
..... :ala
s CITY OF LA QUINTA
cFM oQUILDING &'SAFETY DEPARTMENT,
0 9 ZQ�1 777-7012
CTION REQUEST LINE
y V� .777-7153,
RJT HOMES LLC
Owner
Contractor RJT INVESTMENTS INC
0101-011
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
-
JOB ADDRESS
SFD-PLAN:IRB LOT:43-PERMIT DOES NOT INCLUDE
BLOCKWALLS/POOL/DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE 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
JOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST (�
HEATING & VENT - A/C
I' FIREPLACE ,
ROOF - L
BOND BEAM
O.K. TO WRAP - Q
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE-ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN'SIGNED
DRYWALL INTERIOR , d
EXTERIOR LATH G _
POOL PRE PLASTER'
POGLFENCE &'•.GATE
E EPTIC TANK
`.
FINALS
ELECTRICAL ,
::.•Y PLUMBING
FINAL GAS TEST 7 _
TING-A/C
_,SE NUMBERS
JOB COMPLETED
TEMP POWER
`, ABOVE APPROVALS DO NOT INCLUDE RIGHT TO