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9902-140 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am iicensed under provisions of Chapter 9`(60rrimencing�Aith'Se6tio6 7000) of Division 3 of the Business and Prof, ssionals Code, and°my License s in full force and'effect. Al . License # R. " Lic. Class Exp. Date t Date , 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). as owner of the property_am am exclusively contracting • with licensed cbntractors to construct the project (Sec. 7044, Business & Professionals Code): ' O 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 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: CarrierPolicy No. 07111ali r, 111XV, 031, 934 (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 f • rthwith comply with thoselprovisions . �� Date "{ l e• "i�94I Applicant /l�I �fi r A� 1: �•.�, t �.. - . e 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 fore '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. f • i J � Signature (Owner/Agent)���/�� •• Date `�!�! f . PERMIT # BUILDING- PERMIT 99021..1.441► t .DATE.(' t { �3 VALUATION µ�.,� LOT 44 TRACT 28"197JOB SITE ADDRESS 7'1-«) $t�I1R�itlr�tA ADDRESS lrt€`1-f/iD9 OWNER CONTRACTOR/DESIGNER/ENGINEER t., ►gill C:ri 22$3 ;'1t:C)ENIX A2; x a • ftp"!?.t?��•lri`.-�i €;�'�l.fl ��/3:.In USE OF.PERMIT od..hlt.+LEPAWILVW,Ci1.l.:1lvc t: 3 Fy .,w PLt1,N 3,� 'A: . kM - P t Mt, DOES Wit WN DE 10LOCi: WALLS c .lt Pi.it. L. fdl.AN E-' PXX FEB 1:t9.)tdt :f^;i:) 7$1% i -OR, liAlJi.'T`IVI F, 1.5Sf IANC8 i,3f' C CUSTOM i [�f 7�l: i� J?� fi;o33.�?? SE= !'O'fcCHI'YArIO 130.0b) SF COST OF CO`i�3� +�'IRUC'�Ts.ON 233,748.59 .a1?;STIM'X:a�ED !� j Yp� { lit PCH .la'CHAM� I, i' EIC 1S() I�.ii�,.ikJ�,'C Pl AN, (KIKI'm,1FRI. i 01 -(;1(1()410-3 t•9�?7ti.3t1 - �y.IM--ITA XIC., U, FGi 101-000-4211--000 S1[),.t1tD ELEC"!'RXAL FE1 .10140-4.20-000 S to t.h2 I;}�iii44kilN33 1 G 101 -10W -419-00K) $180.50 R'f'};('itdt'',. MOTtON F — RF SM l t l # A:3M-241-f4fitl ,$2137 n; X)IING FIX, 1.014YOG•423- 00 i2Lt.ttC� :(Y�ti,.12"L`I2,tu CIFURU M7 2-CaOEP-J i t� 12 . 5 <44• ART .I WKMIC PLACES - VESI .: T01-gl 0-2.+5.1100 S334.37 151•,131 r("WAj.f:C)i "i i¢.I.JG"'1"Tf;lyf i'N33 1:�1J {`'.iYfC`b� &7r"3if��lfl 1 . SS i s9.,F-FAM FEES .090.00 RECEIPT. "'ti DATE/ !/r BY 1 �® 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 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 L 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.1. Smoke Detectors Temp. Use of Power Final - pv Utility Notice (Perm) 02/07/2002 08:28 7605646505 RJT HOMES PAGE 05 7 -3 CITY OF LA QUINTA .. BUILDING & SAFETY DEPARTMENT ti 777-7012 INSPECTION REQUEST NE 777-7 Owner RJT HOMES LLC 1y Contractor r, Permit Number 9902-140 POST ON JOB IN CIDIPPICLIDIUS PLACE, INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 79-405 TORONJA . . LOT 44, PLAN 3AGR. SFD •- PERMIT DOES NOT INCLUDE BLOCK WALLS OR POOL TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL l MAIN GROUND SYSTEM GROUND PLUMBING t<.- 4- 7Y ' PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE BLAS JOISTS & GIRDERS ELECTRICAL GROUND WORK D.-AOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST HEATING & VENT- A/C FIREPLACE _ ) �'S _ d..•o 'z t_ ROOF BOND BEAM O.K. TO WRAP GROUT © 4' Cl 8' FRAMING INSULATION PRE-ROOF COVER NO WORK UNTIL ABOVE HAS BEE ,SIGNED DRYWALL INTERIOR 7 77 EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE EW R SEPTIC TANK &X/ FINALS ELECTRICAL I i I Gi a i' PLUMBING s . FINAL GAS TEST i 1NG - A/C AoUSE NUMBERS r JOB COMPLETED I ' TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO