9803-184 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
c14 W Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
l0 i
6 E15 B 6130J98
f o Z r- �D/ate 4 AT Signature of Contractor /`�%
(fl 0
'1 J U (0 OWNER -BUILDER DECLARATION
W WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z( ) 1, 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
LO
N Date Signature of Owner
ON
Q
Q, WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
r Lo H O () I 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
Om � Q performance of the work for which this permit is issued.
Q C.) I have and will maintain workers' compensation insurance, as required by
O � Q Sedtion 3700 of the Labor Code, for the performance of the work for which this
4 � Z permit is -issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
a: S' kT :-.1'LNI D 65-9"-1230
Q (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
or�
Code; I shall orthwith comply with the pr Islons.
,/Date: -��� � dApplicant / n -
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 ;
r� 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) Date4.
'- .,BUILDING PERMIT PERMIT# CONTROL#
DATE � ' VALUATION LOT y�03.1i4 TRACT
8.7=4
=�� 1 �2.14;941.80
JOB SITE 9 `
APN
ADDRESS 50-215 DORAL ST.
769-740-002
OWNER
CONTRACTOR/DESIGNER/ENGINEER
R7T HOMES LLC .
R1r INVESTMENTS, WC.
P.Q. BOX 810
1425 E. UNIVERSMY DRIVE
LA QUINTA CA 92253
PHOENIX _AZ 85034 -
(602)257-16:56 CBL# 4990
�
USE OF PERMIT
ISM
Lin
PLAN 3tB - SID - R:iT HOWS rig LA QMI N c'A MIRW.3YS-19io PLA 1 1-1
CFIE,CA REDUC'T10N APPLfi.D
APR A
CUSTOM CONSTRUCTION 2610,00 G. ITY OF Lk
QU I NTi!'.
PORCI ATIO 140.00 St"?
GARAMICARPORT 493.00,•V
i'1N.k21M1_ T FEE SUMMARY U
CONSTRUCTION FEE 101-000-418-000 $1,1192.00
PL AIN CiiT'CK FEE. 101.0004V-318
MECHANICAL FEE 101-000-421.1100 5,105.00
F�l':E CTRICAL EE,101-000-420-000 1.15 .81
PLUMBING FEr 101-000419-000 $.180:50
WRONG MOTION 1:EE - PESID 141-040-24.1-000. 521,1:9
GttA3JING M5 it11-000423-000 $20.00
I; NN1ZAS'I°ItUC"1'CIR13FEE 225-000-443-342 $4;79.1.' 1
ART IN PUf M PLACF3 - i; 701-400-2.55-000
$(1B40TiXL CON VRL►010N ALND PLAN ClI CK
$11,823.48
LESS P_R.I:-PAID .F'E S
$0.0,0
T'OTA1: PERNIff )SEES )DUE NQw
56,823.48
/^,^tet"•:!
RECEIPTDATE
BY f
DA E FINALED
INSPEC R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings _
Slab Grade —/�-
Ducts
Return Air
Steel
Combustion Air
Roof Deck -7"5;>
O.K. to Wrap _�v-
Exhaust Fans
F.A.U.
Framing _��
Compressor
Insulation =�� 1157-
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
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final 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
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)