9810-069 (SFD)LICENSED CONTRACTOR DECLARATION -
I. hereby affir, under penalty of perjury that I am licensed under- provisions of
,Chzsiter 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
6.9 0645, 6/$0/00
Date r`��'' 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:
( ) 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.
61� 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.
a d'Air, I uND 015.9F, 1."x:30
(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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct..) agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prope`-rtyy f r inspection purposes.
Signature (Owner/Agent) -r?�" < Date zL
PERMIT # CONTROL #
BUILDING* PERMIT
DATE VALUATION . S- 2,14,S!$ti 40 LOT' 30 ' TRACT 21041 -f `
JOB ADDRESS 7.9455 �1M.+'ROI� TA
APN %'6a9 460-QD10
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'R'f ITON41PS LLC
RJT INVESMMIV ''NIS, INC:.
I'O BOX, 810
1425 E. UNIVVRSfl-1 DRIVE
LA QI..T NTA CA 92253
P.[;i13EgtX: AZ 9.5034
(602).257-1656 CBLIf 4990
USE OF PERMIT ! J
S NGLE FAMILY DWELL N1 03 '
S:I: G, LOT 00, KAN 2G, PERv1'ITOGC NOT 1NCLtJ1X3 BLOCK WALL
OR P00L..PI:RMIT FIX' REDUCED 13Y7504 FOR MIJI.T1111X ISSUANCE O
3ANW VIILAN'b`YTIE
Cusi't3.Ri o, ONO S UCTIQN, 2,577 i..00 S
PORCH(PA.710 703.00 SF
iAl2ACa11s/t` Aldk'C)12`1' X22.0(1 3
I STNIAT 0% COST OV CONST H UICTION
21.4,,155.40
P1C,�tiWIT'`:� E SUMMARY
CONSTft17C'I'ION F8C 1011 -OW -4183-000 $1,642.00
PLANC1. HECK YES' 101,-000-439-318 $214A7
NIECr1AMCAL I1T. 101-01M. 421.000 1. CIO
0d::WINICAL M 1.431-0310-�320�000 �:15�.3
PLUN03UNGi -M 10!••000- 19-000
S.)�+fC? �it�s 1'IC?Iti1:F �I; - �;��.0 lCSI-(31X3-2? a-tI{10 121.49
i71'ai�L`Itv'fi 1 10,1-0011-12 1100 S20.00
,iNFRASTCtiit TUU. FEE 125-0004b-342 $4,773.50
AfCf IN PUBLIC; PLACT- S-12ESIG f0I=4)(#0-1.55-000 $287.14
If ioY L CON.S�� ; rMON* A:ND PLAN CHK
4. EC
$6,€09.94
_- � 125S !-R.&RAID FEES
µ OCT 14.1998 �'� 4)t .�� )vs�e�
$65,,809.94
Ur
RECEIPT
DATE / j
BY• &
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
a
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
. Set Backs
Forms & Footings
�`-`
L
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—/p- Qj
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 fop_
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final 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
752—
Appliances
Final
Final G
Utility Notice (Gas) + 1-1
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
Finali_-
Utility Notice (Perm)
COMMENTS:
Earth S stems Consultants ; 79-8118 Country Club Drive
Bermuda Dunes, CA 92201
Sruthwest , (760) 345-1588 • (800) 924-7015
DAILY REPORT OF INSPECTION OF. CONCRETE
SB/R.S CO. GOV. UBC TITLE 21/24. OTHER
Building Permit No.: f DSA Application No.: Date of Inspection: iso
Project Name: �- -...( ( �� t i.� tr ,:.�... it C. Job No.:G�
Project Address: t- -' �- ....i. , i ice. f_. �.. %' f� t: f�i ; .., ^ u �... ! = i <-c
lti.
Architect:. loj tT . Z.� i t ', �-- 1
t _ Structural Engineer:
r General Contractor: ` . - .� T- Sub Contractor:
TYPE OF INSPECTION: Reinforcing , Placement Other �....- ��� ej `� � ' 1 t s S f 11fLe
Description of Work Inspected:
' �� t .} s: e•. N �.. l f \ l �. �/� t + ^ j "'•��
Unresolved Items: _
M
Descriptive Location of Samples: _
SI%mp: Cone Temp: Time in Mixer- Supplier: Admixture:
Water Added: Air Temp: Specified Strength: Mix Design: Truck #:
Air Content, %: �'� Unit Wt.: Sample Time- _ # of Samples:
Field I.D. Marking:
I hereby -certify that I have inspected all of the above reported work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved
plaIns,.specifications'& applicable building laws. Final repoo.issued t� act completion;_ .
(375
Ins ector's Name/No. i� ,� /f(�- LI C�.e:J C'...�'�''�•.� !� 7
p ) e Inspectors Signature
All inspections based on a minimum of 4 hours; over 4 hours will be an 8 hour minimum.
In addition, a y inspection extending past 12 pm will be an 8 hour minimum.
Contractor's Representative
BD -M-402 (19(98) Copy 1 ESC Lab Copy 2 Project Superintendent Copy 3 Governing Agency.