9911-208 (SFD)4. 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. I
License # Lic. Class Exp. Date
690.645
�Dato a %` 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 theproject (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:
O I have and will maintainLa.certificate of consent to self -insure for workers'
compensation, as provided fob"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 tS. CC?AVA.NY—O:Y� •'Y' Policy No. 'i�?f1 Y r> Y1900
(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
subj�ct to the workers"compensation provisionvf-Section 3700 of the Labor
Cdde, I shall forthwith comply with those prove ions ,,.;
{late: i -T 75 Applicant--
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines tip to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building -and Safety
for a permit subject to the conditions and restrictions set forth, 'on his
application.
1. Each person upon whose behalf, this application is made.& each person at
whose request and for whose benefit work is:performed.under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La. Quinta, its officers, agents and employees.
2. Any permit issued as a result of.this application becomes null and void if
work is not commenced within .180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I.agree to comply with all City, and State laws relating to the, building
construction, and hereby authorize representatives of this City to ener upon
the
�above- mentioned property.for inspection .exposes:
Signature (Owner/Agent). Date /9
BUILDING PERMIT PERMIT #
DATE 7 VALUATION LOT TRACTS
JOB SITE ° e a`31 AQP Ri K.'8USS b7/tl4, L AliUVE
APNADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.! _
;�1�f3���.yy.
!!P'AAC.f •811A0
N 1
LA t�Flt�lYTA +..-.A 9225,3
Y.l.4�2P_;1Sk:A.fist�'+dyT ♦�C�ye
�Y=.L7taJ.f'.T..i�.UXI Ail Qdy/.7"i
USE OF PERMIT
SINGLE FAMILY OWELLN43'
LOT a, PLAN 313-87D- PERNT DOE.S.NOT INC LLDE RLOC.`tr. WALLS OR
POOL. PLAN t"H,&"K FEE RWl. CH0 750K, FOR WL':4 Y>PLH 133UNNC.1 O
r,
CI STOI'vr CO3Vsa"RLr: K)3N 2,1610.06 Sr.
t�iJE2+C�Pd,P`�1::T$C� Y4ff.Ui► f3.E`
C3i%k?At3:&`C.AKK)R'Y' 493.0 st''
t{tpl fiC`T.tEC.KF 101-0W439-3ii. s2N.0
IVVIECH WAT,Flu- 1.01-000421-000,
_
'
HL1:C*!PJCAL 178E: S139,fo..
t ILAAWBING IFYItd 5180.30
i
4 R')NC 'AD 3.01 12Y 49'
.v��r r t ar-�fl �:. sc .€,�t
•:� ij
;€ fi*vnzL,CaP�r_,R. mF°ficr Fit~
f4t2'l1Nit}Y�YG:#'�B;fVfis ..RE`1C701•000-T.''5.000
SY3 "fi Yf .`C; r R tt'_►°lt �1' 1i 3�?.Q1;<+1 f�Y FrC;x:�,
t>'t
L05 S MRX )FUS
�•fl►"�r';�,$, �r��R$46'�:5.�' �+'�';,�� �9.3'�'1W'd`Ai�
�3,9JIdr,3�
RECEIPTDATE
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
—/!Y.
Exhaust Fans
0. K. to Wrap
_ c,4
F.A.U.
Framing
_ . r��
Compressor
Insulation
_ rpt/
Vents
Fireplace P.L.
Grills
Fireplace T.Q.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-Z — C43
,
Drywall - Int. Lath
Final
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
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
UU14 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)
THE GAS COMPANY
Centralized Set Desk
Redlands Call Center
Phone (800)228-7377
Fax (800)577-3999
,Fax* (909)307-7050(51)
GAS HOUSELINE APPROVALS RELEASED TO
THE GAS COMPANY
*Clearances faxed a? or after 5:00 pm will be processed the next workday*. t
"Please use a new sheet each time when faxing releases"*
Phone:
Contact: Bldg. Couhter_ Tec .
L760 777-7012
Date: /
# of Pages:
PLEASE NOTE IF RELEASE IS FOR
ADDRESS DIFFERENT FROM PERMIT
ADDRESS (I.E., REAR UNIT)
TRAM# LOT/RLDG # HOUSE # STREET NAME. APT/UNIT # D/
rITY PREVIOUSLY PHONEFAXED.
WOD.
�. CIT.Y,OF LA QUINTA ,
r
BUILDINGS &SAFETY DEPARTMENT
=`yOF „ 777-7012 '
PECTION REQUEST LINE
` u 1y*
�EL 777-7153
Owner RJT Has.W2
aS•LLC
Contractor R-11 T1VVESIjj MNIS, INC v
Permit Number ' ' 9911-208
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-585 SPYGLASS HILL DRIVE
SFD - LOT 5, PLAN 3B. PERMIT DOES NOT. 104. )0-.
INCLUDE BLOCK WALL OR POOL.
TYPE OF-INSPECTION DATE INSP.
FOUNDATION & SETBACK _
FOOTING STEEL 1p
MAIN GROUND SYSTEM
GROUND PLUMBINGyC-11
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB//71 ;
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
D_ AOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST — t'itJ
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K: TO WRAP s
GROUT ❑ 4' ❑ 8'
FRAMING -� - �= ✓ 1�
INSULATION
PRE-ROOF
COVER NO WORK UNTIL ABOVE-HAS BEEN SIGNED
DRYWALL INTERIOR G"
EXTERIOR LATH * • ; V /�
POOL PRE PLASTER u
FENCE & GATE '
SEWOR SEPTIC TANK
FINALS
ELECTRICAL i - 2,;
• PLUM
FIJALGN
n
BERS
JOB COMPLETED
{r TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING