0210-234 (SFD)i , ♦ - . . . - , 11 . r, , i. .
+N 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, BRIO, Al. taf3�ft3fi
Date o e Signature of Contractor _.4�
OWNER -BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that l am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) 1, 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
1 hereby affirm under penalty of perjury one of the following declarations:
O 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 3'!'AU MOD Policy No.
t�
(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: Applicant �_,9 d: 11 &0 ,T-..!
Warning: Failure to secure Workers'Compensation coverage is unlawful and
shall subject an employer to criminal penalties an 7' ivil 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. 'r
IMPORTANT Application is hereby made to the Director of Building and Safety.'
for a permit subject to the conditions and restrictions set forth on hisi i
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 informationi's
correct. I agree to comply with all City, and State laws relating to the buildiri'g
construction, and hereby authorize representatives of this City to enter upon.
the above-mentioned property for inspectiori purposes.
Signature .(Owner/Agent), " 0 1, • � �°r � Date)
BUILDING PERMIT PERMI��
DATE VALUATION LOT TRACT
$243,458.2 60 �i35fi�.t
JOB SITE' '
ADDRESS +B50-375VAMMOMAID
APN
777-39i -W&I
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RX1' F3:OMES LJI. C
� i r WWMAIMI fii sig.
1 A,QUi.D`iT.A1 CA 92253
PHC9RNMI1 AZ 85034
USE OF
'PERMIT
e3M�YJJY"TLWD'YIHVUR
.
S.� • WT b(k PAN SP.I.A.C]. 'PERMIll' nOES NOT l�df:i, U i'� 13U)C'IC
WALLA P60L, SPA OR 1AKFEWX�
TRACT CONSTRUCTION 4,024,0015f?
C3.43dAWMAR:C'{SRT `%i± ,tli'+ Sid
PXMWr.kW. SUMMARY
'CONSTRUCTION FF%Y 101.000.41fi3wtd O 81,143,5
PLAN CI7EV" IM, 19 013,63
M WHA;NICAL FRKP 301-000K421.000 913171110
101 -000-4204= lttd MT7. s2
'�U?sd►WNG I?9 f q < <t3t30 1:�-flUfl � 4a.
S'T.RON0 MO ICY14 FB10 : IZSIT.} 103 -000-241 -000
O*Dtoal.o pa 101 X61 O.423-000 MOO
l�° i.',k?P•F; 11t1;l�lit'1"6 f��r? Qf!,f30
ei'PMLli.id:.A0J.6V Aa'V•.p�J ���c'gS,u`Q1,T 00373C Y yvL,?
_-.._ '�— _._ � 1 k S::.u7nSJ Y..C�'�...S k�'a.LG.� 6.7Calfrni'
:y5,294,c3
t2
�i�!v'•1r^L'
NOV 2 1092 k ,_ A7drz'N.TY.s MIX .n JC:T.r1%.ae�0V NOW
X9432,
4
3 x CITY OF LA diU EA t
FINANCE DEPT. b
RECEIPT
DATE
@Y
DATE FINALED
INSPECTOR
ITS
k
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
)_149-3
Ducts
Slab Grade
_ 3
Return Air
Steel
_/ _
Combustion Air
Roof Deck
a Zy—
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
InsulationVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
—
Drywall - Int. Lath
— 3/
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
Tj
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)
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---° INSULATION CERTIFICATE
This is to certify that ir'sulation has been installed;in conformance. with the current energy R �'t
regulation, California Admirnstrative Code, Title 24,State California, in the building located at: �A
I
50-375 VIA SERENIDAD, LOT 60,LA QUINTA',CALIFORNIA
CEILINGS: 3. .
i` TYPE:BATTS ;. MANUFACTURER: CERTAINTEED THICKNESS: R 38f
t l . 4.4
WALLS:THICKNESS:
TPE:
1"4 y Y ` MANUFACTURER:-CERTAINTEED '
Y
j C T RJT S _,rLICENSE #6
x " -GENE L CT
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TITLE: J(�W ,. • r� P' H
i'.
CTS, A MASCO COMPANY LICENSE # 632072
A N SCHMID-BUILDING PRODU/
TITLE:. ADMINISTRATIVE ASSISTANT' DATE: 11/13/2003
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, _ , r � �� • 1 . r r r W+4..fw•+-• r.. •N { - ', 1 n " � � : . - �i w ' S •• ..
+ • � ,-fir •i "' ; F , '' �-•` �� . v: 1 ,-ry �,�
t
e ica to .of ccu cy-.� r
'='�f•'�Lf-k �,. a. +` `Yf _ ••r :,� j6 ~ r � .• - ti~ tr ..{+':
-��oF��9;Bu�� ld�� n� &-.Sb •Department
:This'Certificate,is�issued�pursuant tobthe requirements of Section 109`of-#lie'.Calfornia`�.Building.:'.
Code, "certifying-;fha"t� at�the-r,tirrie of� issuance,- tliis� structure was in :compliance -with', the '
`provisions :of `the -Building ..Code and the;_ various ordinances `hof the `City: regulating, building,..'
constructiomand/or use:
BUILDING ADDRESS: 50=375 VIA_ SERE�NIDAD
.Use cla'sslfication: •S.F.D: Building Permit No.:, �021�0=234
Occupancy'Groupn R-3' `Type -of Construction: •V=N�� .•, ,= � �� �r,..'Land �Use;Zone R L-.
r
� a• t`
Owner�of Building_ RJT HOMES.LLC , . w' ,` � �, _. � ,• Address P.O: BOX 810
.,.City, ST;,ZIP: LA QUINTA',CA.':92253-
I_ By: FG. SHOWALTER
Dater 01/12/04 I uilding,Officic'41
POST IN A CONSPICUOUS PLACE
e ica to .of ccu cy-.� r
'='�f•'�Lf-k �,. a. +` `Yf _ ••r :,� j6 ~ r � .• - ti~ tr ..{+':
-��oF��9;Bu�� ld�� n� &-.Sb •Department
:This'Certificate,is�issued�pursuant tobthe requirements of Section 109`of-#lie'.Calfornia`�.Building.:'.
Code, "certifying-;fha"t� at�the-r,tirrie of� issuance,- tliis� structure was in :compliance -with', the '
`provisions :of `the -Building ..Code and the;_ various ordinances `hof the `City: regulating, building,..'
constructiomand/or use:
BUILDING ADDRESS: 50=375 VIA_ SERE�NIDAD
.Use cla'sslfication: •S.F.D: Building Permit No.:, �021�0=234
Occupancy'Groupn R-3' `Type -of Construction: •V=N�� .•, ,= � �� �r,..'Land �Use;Zone R L-.
r
� a• t`
Owner�of Building_ RJT HOMES.LLC , . w' ,` � �, _. � ,• Address P.O: BOX 810
.,.City, ST;,ZIP: LA QUINTA',CA.':92253-
I_ By: FG. SHOWALTER
Dater 01/12/04 I uilding,Officic'41