9910-146 (SFD)LICENSED CONTRACTOR DECLARATION
I heZby affirm under penalty of perjury that I 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.
License4 Lic. Class Exp. Date
694wi B
/ate1-/1 'f'`'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).
( ) 1, 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.
3N3',
(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
subjpc't to the workers' compensation provisions of Section 3.700 of the Labor,
9de, I shall,forthwith comply with those provisions.°
pate: el �- ! ��,Applicant .r -• '""
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. 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�pyurposes.
t,SSgnature (Owner/Agent) I "1 � 11-11 Date is
PERMIT #
BUILDING PERMIT,��
DATE VALUATION �,24�♦ �Vi � LOT 41 TRACT �.;JOD �� /
ADDRESS+ "1/5X,W� vtAlcv.O��a.�f�
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Ur I 101MVIS 1.1.c
Pur lmvvnklr�\.'Ts� mc.
P.0 ao 1%, 810
1-425F UNIVEMSrrYDRIVE
LA QWNTA r'A' 92253
PHOLINIX AY, 8.V)3i
(60207-1636 COLO n"`
USE OF PERMIT
aii44�xl,.t�;• �F'►kk9�ll,Y' i!.�t�/!•:,l,�,i4tiCi
4 11- Cil �j j i.f4IV ':; $'yl3Z�i`ff 5?�.7 ::� NOT T3�:� L�1r 7� ill t'a `iti W AL; . (A
l AA_YS*,4 GitiOUCT ON ON PL.4_N CH1XX Ft,c?3 FOR M(fL;!'0.,H !SM-;&NCi
:.7f; SAPS ; PIS ANi'YK.
cliST0111 ONTS'MLiC 'ION ^11,,S13A) S%
, N _491, Sh
D'rI3:E0.A A41k IE1 ) Cos T. o f iI��47;NSTIZU'CIb CON
Px_44NP41 (is
;>f,uumto\L i,;-ra! 'oto _111A -0�
E1.Ed:9°i FEE!0!-°S1W42"00 *3
! l tff4 3.i?vt3 f+'1 �idl •(JL�(ia �' 4 � *0:0 JQ
`t �`t�f i14�t 8i"1'�7F lA1 t+ t� 13 elf) t(kf-�1�{1-JQ3- A11 49
GRADGd] ft,',F ail 11M 4,41,1VA
ARTIN PUIBIM.: i4
NOW
st,943.44
}rrrf��
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 Cd
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing-� (GAJ
Compressor
Insulation
Vents
(
Fireplace P.L.
Grills
_
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath _ �1
Drywall - Int. Lath CtJ
Final
Final� �`� p� �
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines G
Heater Final
-
Water Piping ,
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral I
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
y
Final
Utility Notice (Gas)
ELECTRICAL'APPROVALS
Temp. Power Pale
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) — CEJ
02/07/2002 08:28 7605646505 RJT HOMES .
5 CITY OF LA QUINTA'
OF BUILDING & SAFETY DEPARTMENT
777.7012
INSPECTION REQUEST LINE
777-7153
Owner R.TT_HO
ContractorlII-
Permit Number
POST ON JOB IN CONSPI111P1
INSPECTOR MUST SIGN ALL.A110 ABLE SPACES
JOB ADDRESS 79-445 T RONTA —
SFA- LOT 48, PLAN 2. PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL -
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK c"
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUNDWORK
NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
'ROUGH ELECTRIC '
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM.
O.K. TO WRAP
GROUT 0 4' O B'
FRAMING
INSULATION
'PRE—ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN � SIGNED
KORYWALL INTERIOR
OR LATH
RE PLASTER
POnL-•.FENCE & GATE
AAnVE APPROVALS 00 NOT INCLUDE RIGHT TO
PAGE 03