0911-037 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
C'4 W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
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Z t` Date /r Signature of Contractor "
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J U coo OWNER -BUILDER DECLARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ IZ17) License Law for the following reason:
Z_ ( ) 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).
ce) () I am exempt under Section , B&P.C. for this reason
D7
=c\I Date Signature of Owner
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a z WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q U I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
IlH permit is issued. My workers' compensation insurance carrier & policy no. are:
.�t Z Carrier Policy No.
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(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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provlssions.
pate: 9 ` 1e'i Applicant—
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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 purposes.
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Ii nature (Owner/Agent) Date `� ✓`'� �"
BUILDING PERMIT PERMIT#
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OWNER
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RECEIPT
DATE
BY .K e
DATEMALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
MECHANICAL APPROVALS
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 4, eld Ar 110e
Exhaust Fans
O.K. to Wrapuj
F.A.U.
Framing mac/
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
- —
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
ment Location
rground Electric
rground Plbg. Test
EGas
Final
Piping
PLUMBING APPROVALSTest
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral_
Sewer Connection /�% (�"'�
Pool Cover
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
Utility Notice (Perm)
COMMENTS:
12/11'7200''1'2:55 ' ' 7665646505 ; .,c`.RJT`NOMES:" ;.. PAGE 01
December 11, 2003
9
Mr. -Costly_
50-485 Spyglass Hill.
La Quinta, CA. 92253
PAX 4 7607777-7003
RJT Homes, LLC ht 2 s
RE: POOL
As your inspection has indicated there is no problem with the pool.. All the areas in
question are grout issues which are not covered under warranty 3 years after the
construction of the pool.
Grout is a maintenance item, not a warranty item, and if those items were on the first
Leak detection, the reason they were not repaired is they are maintenance items, the
same would go for your auto fill in the infuiity, that was under water and releasing water
into the lake_ It is also yours to maintain.
Therefore RJT Homes will not reimburse you for the Leak Detection cost and will not
repair the maintenance items on your list: Your pool service'should be able to help you
in these areas.
Thank you,
James Skeen
RJT Home, LLC
79400 Ave. 50, La Quinta, CA 92253 (760) 5646555 FAX (760) 5648555