0107-038 (RPL)LICENSED CONTRACTOR DECLARATION
I. hereby affirrr, Inder penalty of perjury that I am licensed under provisions of
Chapii& 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
65NIX45 15 TWA
Date "" 1r1 Signature of Contractor-
AY- -
_ _ 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.
( ) 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.
(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 thbse provisions.
Date: Applicant
,FeW
rkes
_r.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 represehtatives of this City to enter upon
the above-mentioned property for inspec ion purposes.
Signature (Owner/Agent)=I" y p Date77-
BUILDING PERMIT
.PERMIT#
DATE VALUATION LOT (407-0m TRACT ;.
a «
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
%off"' k ow's, uz
kin INC.
P101 BOX P,10
14" X t7NIVERIy . Y DRM
LA QTANTAX CA 922.53
TYROFNIX AZ 8.:034
(602.)W-1656 CMI !• -4990
USE OF PERMIT
PC K3L PATDI R A
i<'Y OWSPA.. ALi'31•c.?t0MA IER3 SHA.l: L ):IN IN P1,AXT2GAT PR'&PL,AS`iE
moppOTtow, Pool,
POOL, A25i`, OR 9PA'>, I I's
ESMU::S'I.iD MST 44.1:@.t' cd3smt3 `.tox
a'i�flkrt Cii '�✓�y �' L: 101-000-439-318 M05,
C ONSMUC'3'tow v9Z 101-000-41MOO $117.00
FRE -- t'ool., 101v=-421-000 3'24.0 3
ELECTRICAL IPER ,. POCYL 101 �t00-s420-000 $45.00
"i':ErU3AMB1 O 17Ik9 I'f11OL, 101-000-4191-000 $2 .10
W& -W, ',AL 00WH1'R1.iMON AND PLOW (J%VVqX
$289.05
U133 PRE• kid FiMS
$0.00
TOTAL FATMI WhIts.SUE X9W
r4. '
RECEIPT
DATE `` t 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
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 Wali 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 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
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 i
Utility Notice (Perm)
COMMENTS:
04/19/2002 09:01 7605646.505 _RJT HOMES PAGE 03
ALL CONCRETE FLAT WORK SHALL BE PLACE_ D A
INIMUM"OF 2" BELOW WEEP SCIREEDS.. -
s CITY OF LA QUFNTA
FT BUILDING $ SAFETYZEP} RTMENT
777-70
INSPECTION RE UE�T LINE '
777-71 P3 I r , I t
I
Owner RJT HOMES, LLC
ContractorRJT INVESTMENTS, TNC.
• 0107-038
Perm Number
POST ON JOB IN CONSPI ACE '
INSPECTOR MUST SIGN.ALL APPLI— C RE SPA—CE4
JOB ADDRESS 79495 TORONJA
POOL/SPA. ALARMS/BARRIERS SHALL BE W PLACE
AT PRF -PLASTER INSPECTION. POOL EQUIPMI?,NT
ENCLOSURE NOT INCLUAFiD.
TYPE OF INSPECTION DATE INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB "
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
'L -,-NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST l
HEATING 8 VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER: -
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
,TING - A/C
hLJUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING