9902-138 (SFD)LICENSED 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
��U } B Ii/,3VOI111
Date AK / Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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&RC. 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
pe ormance of the work for which this permit is issued.
() 1 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.
tr11 1D y of a
(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 rtFi ith comply with those pfrovisions..1J�
DI�e� 0�
Applicant—
Warning:
�i�
ate: `-�
� C
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.
1vSignature (Owner/Agent) i � ` '� Date
BUILDING PERMIT PERMIT
��x
DATE;, q_ t VALUATION LOT 47 TRACTJOB
SITE
ADDRESS 79-335 T��ia�Ol�JA
APN 769-460-010
OWNER
CONTRACTOR / DESIGNER / ENGINEER
P't•'1.101141:C Yi f"
,.a i to+s nr,.. �.,.r 4.1^
fi'r'1`• y'Rtl+F7<°'1°NTYTI's!"1'(: 0-10 50yp
0.0 r ti. t a:r °.. ,+u., �.� �r� uvc . is "
r .0.110, X bit)
142.5.E. LNj 1VEKSiTY DRIVE
),,t1 QIJIhi'.VA CA 92253
PH()) -,,NIX iNz ZsX) 4
(Cit)^-,1257•-1(�gfi . e'i�f,'� aA�O
USE OF PERMIT
el A+?IFI) -.tP&:.kiku C LXjhS ItCj.t i1'Nha9..0 OIJ , Ety W'r ilfi
l:!!4 ;*`:ti )!.. PI.A.N C-`I`iT;t'fti. ull.
ilF1'r QN3, 'MwiCtT!OR*r
PORCIWIAI'14l "J
i#AAA. 1dk!A1LT'(: KT 5'it3,Ut.3 3
.�w7 A INLU 9.�.4� l.'�,MIT OF 4.ONNI`1�F l�l.�'k � G I' rN'
�.it0,���Y,�ai
t�7g���gqgg ��t,�� {{ 6y L ``i'pp S� y,y',,��
CON'STR.UCIrIOd.`tFf<`E 101-000*418-0(g) �).,1�#.�t►
aryl- HANIC.AL.C3 I0�»Gili?• I (i(raI )if►5,f10
ILfsC11RJC.J%L("pI: 161.-itUti- aC Uik) �Itr).�
iPi lIfM1)ING FEE 101-000-419-000 $llit). Stf
STRC)W(I W) TTf)W FW » RF ATT) 101 -MD -''df -(N9t1
GRAD 0*40 FFE WI srta.t3tf
IIdI�,4tA ' 'k> i �'t�Cck T i r 2B-000-443-342
ARTIN PUBLIV PLACES - I*',VU /0I -010A) -2N -0030 5XM31
y°t 1R-TYi A T. Ct1L'`I"I� t �1P •I�rt,��� .�11V!"1 n3,,a fN('FC"f:
w.
LESS PRI.1*41M.DiTfs
t'CJ.IAL Pr -,K 1T FU'J;.S W)K NOIR
7�uwFKV(T.�yV�
RECEIPT
DATE w, d"F
BYr 0'i
DATE FINALE` INSPECTOR
,.
V
ip
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 Pibg. 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
Sewer Lateral
Pool Cover
Sewer Connection V I
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:
01- -L lr^ 1 l C S }GCC
1
02/07/2002 .08:28 7605646.505 RJT.HOMES _ PAGE 06
CITY OF LA QUINTA
BUILDING 8 SAFETY DEPARTMENT
777-7012
INSPECTION R l� JE
7�"
777
` Owner
RJT HOMES -LLC`
Contractor RJT TNVESIMx
Permit Number. 9902-I30
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES i
JOB ADDRESS 79-385 TORO.NJA
LOT 42, PLAN 3BGR. SFD - PERMIT DOES
" NOT INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION a SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING r
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALLABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
Dw,40T POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC _
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING 8 VENT A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 08,
FRAMING c{ 4-7
INSULATION
PRE -ROOF -
DOVER NO WORK UNTIL ABOVE. ^,S BEEN SIGNED j
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
I SEWER SEPTIC TANK
FINALS
ELECTRICAL 3- • I , G h'
PLUMBING
FINAL GAS TEST 1.2 C
26
1 NG - A/C
NuUSE NUMBERS
JOB COMPLETED
TEMP POWER
I
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
Ti ION nN i iTH MPA OR r)r:r:I1PY 9UILDING