0002-175 (RPL)LICENSED CONTRACTOR DECLARATION
I 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 # Lic. Class Exp.. Date
69W45 B HIC A
Date` - � _�'- ^','2 Signature of,Contract r
d
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 �r ! Policy No. (� �/y
01 1.V iSt'CUY S, `1I, Y , 1� 1�L.V•I lM
(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 pro "of Seciion 3700 of the Labor
Code, I shall forthwith comply with those prouions.
�: ! -'
Date: Applicant �/�✓ ��
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 auth'rize'representatiives of this City to enter upon
the above-mentioned property forinspection purposes.
Signature (Owner/Agent)!r rrt Date�7?-1
PERMIT #
BUILDING PERMIT 114110217.N
DATE 1� / VALUATION LOT TRACT
JOB SITE APN
ADDRESS 50-486 SPV GLASS MA,
OWNER ' CONTRACTOR / DESIGNER / ENGINEER
RYr 1P1C R!'1' trt �r ;cT�tr,rii's, m'c.
1425 E. bNIVERSITY DRIVE 1415 E. UNIVI RSi'1'1' DRIVE's
PRUENIX A!. 8-%134 PHUIaNIX AZ 8N) -34
(.602)257- 1(;.% CRIN 400
USE OF PERMIT
PCX)!, A DJUR SIVA
POOL In R °A G13 -LY - p1I..Ak'f 4la/iif !'{1LR:i ia'SIALL BE W PLACE AX
PHF,-e1,A:;1 ER INSPECTION.
VALUATION
^r
10.000.00 L
OESTINIAT OEM CM OF CONST RUIC a01"I 191010,00
PEIR1WTL' FF -E SUNiA`erWN
P1. AN CHF(X 1;1 1,01-000-439-3113 SWIJO
+�2,gfu"i"TG?1,iT`F�
ow.csltlfX.4tCAL
i1E f RiCAL Fill— POOL 101-00042C-000 i�tb.utt
PLLfMIAINO F �E -- KXX 101 -ON -419-000 ti27.tff.t
Sf t -7 n�'a r, f `t )?VRi i l(�i 1C)T+t . AFD Pl,,p IV CFI>Mf'K $?RO 05
LESS PRE PAUD FEES WOO
#'(YfAI, 3'EItMIT MEN 01ANOW $289.05
RECEIPT I DATE
DATE FINALED I 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
c�J
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
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)
Ask -
SIZE 14' X12'
AREA 177 PERIMETER
DEPTH_
OWner: RJT Homes LLC
_
TILE CHOICE
Box 8 P.O. 0
La
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COPING CANT
QUlnfe, CA 92253
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POOL CAPACITY 71380
PUMP A 103 GPM
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PLASTER COLOR
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DECK TYPE SOLNHOFEN QUARTZITE
STEP 2 FT. 12
SPA SPECS.
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SIZE 7X5 RAISED
.YES .18"
LITE 100 WATTS
TRI LEVEL SEATS 22" 24" 27"
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DAMWALL STAIRSTEP
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DAMWALL TOP QUARTZITE GOLD
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