9910-145 (SFD)LICENSED CONTRACTOR DECLARATION
hereby 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. .
License # ttLiic. Class Exp. Date
qDate' ` Signature ofContractor
-�"'�'�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
('y4 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
Cppfie, I shall'forthwit�,f com;leply with those provisions.` 1_ "
NSate: // /c /' Applicant—
Warning:
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 p>7 poses:
moi' fir .
bSignature (Owner/Agent) � Date c
BUILDING PERMIT PERMIT# /
DATE VALUATION / �wia :��3 LOT { TRACT M`2Yj
It /JOB
SITA
ADDRESS %�o .�! Y�ID,atili
APN 7610 -M -M.9
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ri M. t7tlAf�1T� 1 "/ iv
"f A.t� 11 .l t.l� ._
Li i�t'Ta�tlY/�.i\ r'{1.iQ11 'r`C rAT/•�
r�.! I! a�. • ..ef t4�4s.. i- A�.>y f%J0
i423 & UNWEIRISITV DRIVE
LA Q(f{lti'_i'A. CA !Q2t 3
PkiUFNIX A M0:4:
(Ci�"+'�l�i3'..{�`�,, 4"'I{,� •^.;`,'hili
USE OF PERMIT
aa.04GL t flibil�. i' 1111Yf~�,l,9lti r
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f ou11.,,`iY6 Rl Lf)kll `1100 ON PLAN ('HfA:K N-3 E.E (Dkk fvfiJLTIVIX, ANKX
OF SAS lF PLAN 1"M,
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MW MIM ED CV3T OF, CUNSTRIXTION
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ART IN KYBLICo !PLACHN - ItIISIC 334, �7
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
QATE
I 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
—
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
. C10
Drywall - Int. Lath
Final
""
�i(p_ �} �/,Ci
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
71-42
Heater Final
Water Piping
i
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) _ uJ
I
02/07/2002 08:28 7605646505 RJT HOMES
.r-.-r.-rte..-.nr ....-.u.u-.-•....wMww....W .w.r...Fr..H 'w.w .ws.. � .. ♦.....1 +C. w4.. w.
CITY OF LA DUINTA.
+, ' BUILDING & SAFETY DEPARTMENT •
`M pP
. 777-7012 .
INSPECTION REQUE L 15
777-7153 d
Owner T RJT HOMES LLC id l If -
Contractor
• Permit Number 9910-1.45 �� 1� L• �_ '" `-r' 1�1 "
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
�J013 ADDRESS 79-435 TORONJA'
SFD- LOT 47, PLAN 3R- PERiVHT DOES NOT
INCLUDE BLOCK WALL OR POOL.
TYPE PFINSPECTION DATE INSP.
- FOUNDATION & SETBACK `"'��`
MAIN GRO ND SYSTEM
GROUND PLUMBING V7 72 5! K
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTR CAL GROUND WORK
v_ n10T P UR CONC ETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROU H GAS & GAS TEST 1
HEA NG & VE T - A/C
FIREPLACE
ROOF 1 u; •- Gila
BO D BEAM
O. TO WRAP`
GROUT 0 4' ❑ 8'.
FRAINC
INS TION
PRE- OOF
COVER NO WORK UNTIL ABOVE HAS AtEN SIGNED
DRYWALL INTERIORLa
_ v
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
EWE SEPTIC TANK
FINALS
ELECTRICAL ��� -
>. PLUMBING
FINAL GAS ZEST CU
TING- C
X10'us
E NU ' BERS
JOB COMP ETED-
NlP ER
_ ABOVE.APPROVALS DO NorfNCLUDE RIGHT TO
PAGE 04