0002-178 (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
(190643 105411c, j\ /I-,' Wi3W210
Date Signatureeof Contcto
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 L. Policy No. 8ry1`L1A t}}Y_�. 'CoAA'A f 0117
1W /!U
/(This section need not be completed if the permit valuation is for $100.00 or less).
A( ,�Itcertify 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 i- ould become
subject to the workers' compensation provisions of:Section,3700 of the Labor
Code,, I shall forthwith comply with those -provisions. /l
Date: 7 ojLE�f r Applicant-
Warning:
pplica t -� --_-
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.
BUILDING PERMIT PERMIT
#
DATE j ( / 1 j '1 VALUATION & fl.tMj),00 LOT TRACT
JOB SITE
ADDRESS ��rA�6Rii SPV �.d�aASSS� I ULL APN
OWNER CONTRACTOR/DESIGNER/ENGINEER
W25 E. LWIVEPISIi'i'.iAI.VE i 1411 E. UNIVEPISITV DRIUF
Pli. AINIh' AZ 85034 PHOENIX AZ 850-14
rF+ti^,�s7.lE� rr�r.0 1t�
USE OF PERMIT
V013 . & SPA ONLY - AL -,%i MSA3AVRffiR8 IfiV.L 06114.1. Afti iiT
fHty:-t'i.A.�►'3ilt .iNtit'1_it:."?')t_�N. R
v`ALUA1iON
10,000.07 L
0 AJ.VA 'AL , p\ !� 3 E\741s f4:1'AlC�T !'tfl�7`ilil�i
ua L�l�lt . t full
izfMa�2Tvv,I's' Vii+. $'lTc"a3t�iA��� .
KM4 VW!t CK F'E-E (01.40Ki-439-3'IR
{"f'11J;ATRITS;:'f'fOAT� bi)l•d 1(1-cfi�i-iK1!? -41 17.(N)
LNECTVUMCA31lMIX -P00L .101-000- 4211-0000 S2.1,00
al;C`i"; t CAI. f t%T --,P00.1. 101.000-420-000 &45.011
ILL Mf M FO-,' -- .LV*kX)L 101-(M-419-000 527.00
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 Stat laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for i�ction,pu�poses.
RECEIPT
Signature (Owner/Agent) / �� ) "- Date
St P-'1'(Xt'M.; CON "ZM t(MON ? N*f) PT ANC'1JFr-
LESS 1 RZE-1'11.iL; FEES
'ITt)TNI, PERMIT I:I+'EN H:1QJC NOW
I
DATE BY
DATE i I DATE FINALED
S!3iy.0
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
cv
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
-
Underground Plbg. Test
G
Final
Gas Piping
_
PLUMBING APPROVALS
Gas Test
Electric Final
v ��
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
—02
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:
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SIZE....... _X2L;..._._' �.
AREA, 177 PERIMETE 57
DEPTH
SQ. 50'.t
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Owner: RJTHomes L i .;;' Ijc CODING CANT
LC ... . , , , I� , ,� r �-�•��
F.O.
Box 810 "-� •�• •
La Quinta, CA 92253 •, ' ___._ .__ _ _��,.t �! ;` ,
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FILTER STA RITE 300 '_SQ FT
FILUR_MU-_ - - 102 GPM
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DECK TYPE SOLNHOFEN QUARTZITE
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SPA SPECS.
SIZE 7X5 RAISED .YES
LITE 100 WATTS
RI LEVEL SEATS 22" 24" 27"
DAMOALL.• STAIRSTEP
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