9810-075 (SFD)LICENSED CONTRACTOR DECLARATION
l,fl-hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commdncing with Section 7000) of Division 3 of the. Business and
q Professionals.Cbde,"and my License is in full force and effect.
License #� a ` t y S�Lic. Class Exp. Date 100
&130
Date✓U/Gl 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:
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
(p formance of the work for which this'permit is issued.
L) 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.
A 16'r
(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
Warnirl 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 I
(£i
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 'I
& 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 H
the above-mentioned property for' Ipection purposes.
t
ll-
Signature (Owner/Agent) Date
PERMIT # CONTROL #
BUILDING PERMIT
Wil
DATE VALUATION $2,14,W5.1.4,0 LOTSI TRACT
. - 38423.
JOB SITE
ADDRESS 79475 T�A, ��.i�.;sA.
APN
76.9-460-00-9
OWNER
CONTRACTORDESIGNER(/ ENGINEER
V
101"H0TME'5 LLC` t
R/
R(�f .�114V1�!.7SIM11✓KfS, INIC,
Po 13ox".&iu'
d s E. UT1il€TV DIUV ;
llihE`Ai?
lZ8503-47'
O
ZNIXLA
C:1 I10 491,V
USE OF PERMIT
S.i-D, LOT # S i PLANi t, FTIR 414' DOLS NC:•1 h4COTYE ErLOCK WALL OR
POOL: '!'o'iA•- n; Fix-, k21 f ucra) ,Ry, .7.501" F f 31'a mul...M.6 XSSfJ:ANC F, O
SAiV1F .PLAN TYPi,
CUi1'GILI t:tri�iN`Ti'�13(:`1;IaO1V 3,S "0
PORC`liil•'.14zi: -10 203.00 W,
GARAQE1CAR1 QWF X32:00 SF
SN�rC li'.lk Y ED COST OF CON.T RIT� - 1.10N
-114,41 y3•J.W0
PRMUT FEW SUMMARY
-CONS'l'.ibM1,1•109NFFM $(1$:-0D1i• 1 -t3Q0 S1.1l
PLM 419lI.T.F g-214.47
1viKliEt ICALFEE 101 -000 -17a -NO �111.5U
ra::r�: •�-1zxe�Ar..1'1. z 10t-0000-42c�- OO S1.59.341,111UMBWO
tTk 101-006AI9 i= �u1$0.iti
SONG pr?QTK N FFE �S1n :1.014Nii)•241 000
OAIRADIM7, PEE 101.==423-000 $20.(11► .
-
rwq iwa1tUt7l'onPm 225-000-443-342 S4,77-1. so
AKr 1'N' PUBLIC P:LACFSR -- RESIC 701.-W0-E5rt-0W Sit/. W
u 11 i Z A?CON c � 1_ UCTiON AND PLAN CHECK
S6,809.'m
LESS PPE-•t%,UL11FEE0 .
' $0.00
OCT 1 4.1998
`!.'OTA:L Pk:3t114fITM:S� :0UE NOW .
S6,809.94
- TY A l't
RECEIPT : �
DATE
BY
DATE LED
INSPECTOR
-L z. 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. f_
Fans & 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
Temp. Use of Power
Final
Utility Notice (Perm)
FROM RJT-HOMES ..FAX NO. 7605646505 Jun. 21 2001 11:58AM PI
r-11TV OF I A QUINTA
tDlt SAFETY DEPARTMENT
R7,1012
INSPECTION REQUEST LINE
4.1999 777-7153
O%Vrw. RS LLCix
Contractor
Permit Number 9810-075
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE'SPACES.
JOB ADDRESS
SFD, PLAN 2G, LOT 451, PERNHT DOES NOT
f INCLUDE BLOCK WALL OR POOL
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 SIGNEC
CONCRETE SLAB
JOISTS"9'GIRDERS'.--'
C+._4OTIPOUR 'CONCRETE UNTIL ALL ABOVE AS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING& VENT- AIC
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 8'
Z `7'erl,
FRAMING
INSULATION
PRE—ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POO� FENCE & GATE
�EWtR SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
)Nrx - AIC
"SE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
ccupancy
Certificate of O
.
CityLrw,
of
` - C• � ,.O�Sw
Building'and Safety Department .
This Certificate issued, pursuant .to the requirements of Section 109 of the" Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances _
of the City regulating building construction ,or use. For the following -
BUILDING ADDRESS: 79-475 TORONJA
Use Classification: SFD Bldg. Permit No.: 98+10-075
Occupancy Group:. R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC Address: 1425 E. UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
- Date:- 6-21-01
Building Official
'POST IN A CONSPICUOUS PLACE