9908-080 (RPL)LICENSED. CONTRACTOR DECLARATION
I, Ire$y affrrm�under penaltyof perjury that l 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-C'G s � ,/may Exp. Date
'Date � � Signature of Contract9f' �
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 rriy, 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).
O 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 corisent to.self-insure for workers'
compensation, as provided for by Section ab
3700•of the, Lor Code,, for the
performance.of the. work for which this permit is issued.
0) l 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.sect n'need not be completed if the permit valuationis o$1�0 00 orless).
( ). I certify that.in the performance of the work for which this permit is issued,
I shall not employ any Person 'in any marines"So as to become subject to the
workers' compensation laws of California,: and -agree "'that iiff,l.should become
subjeet'to,.the workers' -compensation provisions'of Section'3700 olthe Labor
Spde, I gi@1�6ythwif^F omply with,t�h, 6s`eprovisionsFoe�
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 atto'rney'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 persomat
whose request and for whose benefit work is performed under or pursuant.to
any permit issued as a result of this'applicaion agrees to, & shall, indemnify
hold harmless the City of La Quints, 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 •witFi all Cate l
ity and�Staws relating to the building
con t(ction, and hereby authorize representatives of this City to enter'upon
th above-mentioned property for i :'s-pec'tion' purposes:
Signature (Owner/Agent) Datef
BUILDING •PERMIT : PERMIT#'
DATE VALUATION LOT ' �� -_on TRACT
JOB SITES
APN t
ADDRESS
OWNER CONTRACTOR / DESIGNER / ENGINEER
RM OMS ULC Rif Imtmomm,, wic..
PO BOX 810 IQ5 E. 1;lK1V1rItSY"ry, DRIVE
L14 T<3L4WL A, CA. X233 FHONIX AZ 95034
�75a C6fBL# 4990
USE OF PERMIT
O /
6A ..
POOL & SPA, ONLY - ALA1t,€4 919 Ai1MERS'11W.L D1 YK PLACE .kT
PRi.,P1.A9'It'"1�'t' INSP'FFMTON
Pool..Aimvm SPA 10.W0.00 LS
HSTMIATE 0 COST W* CONS @"UM:.#:;iJN
13 ,000.
PERMIT .FIER SUMMARY
PLAN CHEM FV 101-000.439-3113 6 6.03
CC3AiSTRU1 1'10N FTE 101-C1ifl-418-000 111.00 .
WCHANICAt F•3T. POOL.', ' i0.1 11*421 924.00
ELECTRIr AL TNY-k -,. �PQOL 1014)tltl4204 ) U100
PLUMMB]Mv.FM=.POOL 101.-000-4.19-000 W.00
sib-TcXAL CON' IDR tr."110N AIMD PLAN CHKK •
����.�
LESS RE -PAW FUs
RECEIPT
DATE
BY
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 I Exhaust Fans
O.K. to Wrap E F.A.U.
Framing Compressor
Insulation Vents
Fireplace P.L. + Grills
Fireplace T.O. ; Fans & Controls
Party Wall Insulation i Condensate Lines
Party Wall Firewall
Exterior Lath i
Drywall - Int. Lath
Final
Final POOLS - SPAS
BLOCKWALL APPROVALS Steel
Set Hacks ; Electric Bond
Footings
I Main Drain
Bond Beam
I 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
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
Temp. Use of Power
Final
Utility Notice (Perm)
04/30/2002 09:09
m
r
7605646505 RJT HOMES
0
CITY OF LA QUINTA
i - BUILDING & SAFETY DEPARTMENT
OF
INSPECTIOI'AEQ EST"LINC,
TI7-7153
AUG IS 1999
owner ,JT HO�VYES LLC
'I Contractor ., ,... 7,.n . �r._M.r ..*^ ..
Pemft Nur»r_ 99as-a- _
POST ON JOB IN CONSPICUOUS PLACE
be
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS _ 79-365 TO O
POOL & SPA ONLY - ALARMS/BARRIERS
>i SHALL'BE IT PLACE AT PRE PLASTER
iINTYPE OF INSPECTION DATE INSP.
"OT POUR CC
ROUGH ELECTRIC
ROUGH PLUMBIN(
ROUGH GAS & GA:
BOND BEAM
O.K. TOW AR
UNTILALL ABOVE HAS BEEN SIGNED
C
UNTIL, ALL ABOVE HAS BEEN SIGNED
ALL CONCRETE FLAT WORK SHALL BE PLACED A
MNIMUM OF 2" BELOW WEEP SCREEDS.
PAGE 02