0402-291 (SFD)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
690645 D 137C A. 6130104
Date/,� --/ 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).
( ) 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 STA71 E FUND Policy No. ! 093906-01'
(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
Code`
"I shall forthwith comply with those provisions.
[Date:{T 12, Applicant ',- 70 .144,4 '
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to' the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date 14. 1 --ge;
/%
,BUILDING PERMIT PERMIT# .
DATE ,J VALUATION LOT �ia''191 TRACT
I K�
l Q S-2 jS.42,5 17 29858.2
JOB SITE % ;
ADDRESS 1&425 VIA AMANTE
APN
7.7.1-05"10?
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PO.BO:..610
142.5 Bi, TiMMMY DRIVE
LAQLWA CA 92253
PHOENIX Ae 85034
(602),237-1656 ri3Y0 4990
USE OF PERMIT
SWOURE FAWLY AT MC
SPA - LOT 17, PLAN F18. PERMIT L O&S NOT INCLUDE POOL, SPA,
0L0CK. WAU-11810R DRIVKWAY All P.ROAC14
TkACT CONSTRUCTION 2,894.00 OF
PL RCH/Pmto 967.00 SF
tIA:i3IACiWAI°eFORT 457.00 SF
..1391�1�TiA�.'.�+'.,.ij COS t., Off' CO3�IS'3'�Ti1C".$'AOn
1x71,632.50
►�y;v�y�, ^� �p �q��
d'17s34SV.4i3�ITE, SR.7,t�.lSV.3h3�.✓�F.X.
CON3TRUC TI N FEE 1€11 s0t70.4 r 8-001 $912,30
PLAN CHECK FEE 101-000-439-318 $770.67
MECHANICAL FRE 101.000.421.000
ELECTRICA- IEE 101-000-420-000
PL -Ti BiNG FE.L 101-000-419.000 $208.00
S9`RONOMOTION FEM-RE;ID 101-000-24.1-000 $1776
GRADING FEE 141-000-423.000 $15,00
DFVZId7VRR JMPAVr 7911 yF�01.00
MM—TOT-AL COW= l'°'1'.r�:+N AM PLAN CILECK -
$4,189.86
LESS P PA17a 1�T�
$0.00
_ I
hL PER, NOT ITI-M S DUE NOW
S4,169'"
APR 012004
CITY OF LA GUI A
,
F!NANCE DZ
RECEIPT
DATE
BY
DATE FIN ED LINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
!s / -
Return Air -
Steel
21,/ -
Combustion Air
Roof Deck
-
Exhaust Fans
O.K to Wrap
_ 3, 9 4F.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 171
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
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
_ j4
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) '—
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring _
Low Voltage Wirinb
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
U61ity Notice (Perm)
41
..fit ,. y f.. ^i ; ` .•f F• }� -3 _ . •. - 1'_ .tel= F -
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- - _ � Vii• ^..' w . - j , b f _-(t - j7' '
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t
�caee oun deCcaa_
,U.( X91 .. ' S } _. .. ( •, * ), r. .- J YM
> u�i'�ti6v
OFBuildin &, Safety De artment
V
+r • i r r.. ., ° ,-„{• 1 - ;r '< ,tip .� _ ..
-This Certificate is, •issued_ pursuant 'to'the, requirements of Section,,109 of the. California Buldin
9.
. Code, certifying that, at�_the .time of, issuance, -'this. structure was"'in,.compliance with the <.
provisions :of 'the Buildiri "
A J _ g 'Code and `'the various ` ordinances of the City regulating 'building
construction -and/or use. �t V
BUILDING ADDRESS: 50-425 VIA AMANTE: '}
71
Use classification S.F' mit No D �t _ ': ,. €� Building°Per -u
- 0402-291 _
Occupanc G,R=3 � � : , , ..� �, T
Y rou p ype, of `Construction: V -N r 'Lan' 6 Use -Zone: R -L.
-. Owner of Building: R.J.T'`HOMES LLC a y�� t• ; Address 1425 E. UNIVERSITY DR.
City, ST, ZIP: PHOENIX AZ'85034 ti
By. G-SHOWALTER 3 d
s
�> ...........
r Date:' 06/01/05
, ;Building Official ; ^f.
PL
POST INA CONSPICUOUS E