0101-010 (SFD)LICENSE D.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 °`'�' +�_ •^rte
. t
u
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 properly, 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).
( ) 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,.[ shall forthwith comply with those provisions.
Date: - 'Applicant ., P # 0. -�
Warning: Failure to`secure Workers' Compensation coverage s 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
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/Age It)../ ,•r,. M .• / r' �� Date)=—.5/-
W • f r'
BUILDING PERMIT PERMIT#
DATE / VALUATION LOTTRACT
V_ 14 4&5'5�40 42 29447
JOB SITE
APN
ADDRESS
.%C'-590 RV,fUTA,RRC3
OWNER
CONTRACTOR/DESIGNER/EN (NEER
RXf, HONTS 3 ul
RJT'.N--'i71✓;a'"TMWT8, INC.
PO NOX 0! 0
1425 Z UN11lMR.'S" URTVR
%A QUINi TAC CIA .0 ,2 53
.I>H(602)257.1656
�/yyi�.�ii1rr3Cyy pp ¢ p ,t�ppSC1} 99[
USE OF PERMIT
SMILE
NVD-9I'.uFE14.2S f '7°Q2� �.�1� ii f�LUf� 2dPJ't' d;QCF;ilL?k?
F.kl,X)C,'K*'t%,I,IPOOIJDRIVP,WAY APPROACH
CWYN'6S'Y. yI IRS•t2.3VC"iION %57/,0 NJ'
t
SF
PORCFIIPAT-1110
p20100
�.��rRt�.���.�.�GRTOR4.'f' (0n 1l,407.2A e
) ITMIAM) COX "0I+, C:'ONS'UM"I°.€OA,
C'C.tNKRUC1T'IONV .tom:& '101.000:,11 8 -ON $1,042,00
:{aWCHANICA!,FEE 1L�1�C�t0��3-�f!iE �1ia.5fl
1'$,,'(3Ml 13 FR 1Cfl.atfiiF0�11 •Ot3C� �fl fil.
5 ",'�-fvFHO MOTION PZ'E • RP-11ll 101-000-241 -000 �2I.19
411VAOINO FARE 101,-000 X21.000 ='60
v7VJe,L,•0PX, IMPAC', FEE $11907,L't'c
ART IN PUBLIC PLACES - RE,11. 701-000.2551.000 W4 14
TE =36 TAl.� C;�JMTT4�I0C'.`.CIC3,aa �T�Y� s � i�Ci1*s"'K.
V71,�:"sEi.
3d 7:1 !�2 5•k"F J
$0.00
0�
HtCEIF'T :
DATE
By, "F
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 ��� TJ2 ���
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final 1 11 1
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
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:
FROM
FAX`NO. 7605642238 Apr. E2 2002 10:08AM P1.
)ITY OF LA QUINTA
SOFT 4 NG`& SAFETY DEPARTMENT
777-7o12
� t LA
Qt ION REQUEST LINE
-- 7-7153
Owner PUT HOMES LLC
Contractor RJT INVESTMENTS INC
Kermit Number 0101-010
POST ONJ08 1N CONSPICUOUS PLACE
INSPECTOR MUST SfGN ALL APPLICABLE SPACES
JOB ADDRESS S0 -S90 NECTAREO
SFll-PLAN:2B )LOT;42-PERMIT DOES NOT INCLUDE
BLOCKWALl S/POOL/I)RIVEWAY APPROACH.
TYPE OF INSPECTION DATE
FOUNDATION & SETBACK INSry
FOOTING STEEL /
MAIN GROUND SYSTEM r
GROUND PLUMBING
PRE-GUNI I E
DO NOT POUR CONCRETE UNTIL ALL ABOVE HqS NEp
CONCRETE SLAB BEEN SfG
_
JOISTS &GIRDERS
ELECTRICAL GROUND WORK
I IOT POUR CONCRETE UNTIL ALL ABOVE HAS SEEN SIGNmE
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
-
HEATING & VENT -A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
COVER NO WOI
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
PO L FENCE & GATE
EW SEPTIC TANK
PLUMBING
FlNAL GAS TEST
)'^' ING • A/C
,SE NUMBER;
JOB COMPLETED
TEMP POWER
K UNTIL AB
IS BEEN SIGNED
- U7
ABOVE APPROVALS 00 NOT INCLUDE RIGHT TO