0201-038 (SFD)_ -LICENSED CONTRACTOR DECLARATION :
"I`liereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing .with Section 7000) of Division 3 1 the Business and
Professiona s Code, and, my License is in full force and effect. =9
License # Lic. ClasstExp. DateBT ic
C
Date L" � `"'Signature of Cont"racto� 'F� rF �l +�{dy;�'_ �-
o
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.
�() 1 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�� Policy No."
SFA 'Y:e FUND:5839: -101
(This section need not be completedif 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 tdbecome subject to the
workers' compensatiori'laws of California, and/agree that if I should become
subject to.,the workers' compensation p`rovis'ions of/Section 3700 •of the Labor
Code, Ikshall forthwith comply with thdse prrovlsions.
Date.•*i {Applicant
• � f
V Warning: Failure to secure`Workers' Compensation coverage is unlawful and
shall subject an employerrto 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 pursuan o�'
any permit issued as a result of this applicaton agrees to, ,& shall, indem i
& hold harmless the City of La Quinta, its officers, agents and employe
2. Any permit issued as a result -of this application becomes null and vol i
work is not commenced within 180 days .from date of issuance of s
permit, or cessation of work for 180 days will subject permit to cancellati n.
I certify that I have read this application and state that the above Informationis
correct. I agree to comply with/ all City,,q�and`,State laws relating to the b ildl g
constructlon, and hereby authorize representatives of'this City to ante upon
the above-mentioned property for inspection purposes.
Signature (OwnerlAgerit)'r' �i✓!�"`� µ Date-'
µ� BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
6.5
JOB SITEAPN
ADDRESS
W4,10 WA. fiKUP.'.1` 6.,r+.0
772,Mg4)4X3
OWNER
CONTRACTOR / DESIGNER / EN (NEER
QJ T 11MES L C;P-TT
a3�f�J',r�i3iw"N. 1KC,
:i O DOX 810
14,25 DRIVE
.1.,A(XIM 0-4 92253
RR, 0 K 11 K AZ 85434
'(60 2)257-1636 C;'B19,, 49901
USE OF PERMIT •
S * k,i3i d�'i�i.A�3 �T��f�C:�#. 3%L'�14Bid I3°.�"�'�.,'-s .V6,:Y�r;`3t@!s`i.3.F�t✓ )�►,.�3b�%.
PORCH/PATIO - 959,00 SV
'
1240 OF
ES.ACit6Y3iSi1114) CoM, co-, C!(1NIMMUC-110N
SUBOVIA Y
CONSTRUCTION P7rE 101'.000-9.18-000 S1,210,0
PLAN CHECK Fr ?V1, r0l.,0.0-439- 16 $1,037.33
E1,ECTUICAL V84 101-000-420-000
%Lf.JE'li:43n1Ci RU 101-000-419-000
STRONG MOTIGH ftAE - IiMS1U 10-1403-241-0.00 $M.aa
lil,"1A`VIOPE11WPA17, ' YEE, v1,�ta1lt0
ART IN PUBLIC ?LA. M15 - W11270-000-441-000
MAY U 2 2002. '�°i�� �nmrmrrcrosri. o
WYOFLAQUINTA
FINANCEDEPT
RECEIPT
DATE }
BY /
D"A`Tf..FFINALE
INSPECTO
.s
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ductse."? )17
Slab Grade
U
Return Air /
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
, G /L.
F.A.U.
Framing
_ p _ C__
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
-
O,.v a/L- /✓ft,�.s
Final
Final
_ f
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
C. 02
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans`
G 2--
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)
- >
' 4 Page 2 of'-)
14712 SW SCHOLLS FERRY
# 328
�• BEAVERTON, OR 97007
PHONE: 503-5248268`;, ,
FAX: 503-213-6222 f '
E-MAIL: mjnelson@attbi.com ,•
• .fir • . ,
John Hardwick r
RJT Homes, LLC a -
79700 50"' Ave "
fi LaQuinta, CA 92253
14
RE: Structural Observation of: Palo Verde 'Option B Tract 2985.8&1"' "''`"°'► ."
` - Lot 63 Plan SF? 710 Serenidad
~ , John,
A sizeable sample of observations were made of the above house to ascertain whether the ,
' intent of the construction documents is being followed. Of.the structural items that remain .1 '
uncovered and easily observable,. it appears that, in general, there is substantial compliance ith
the constructions documents.
s
* Please call with any questions.. pFESSj '
Sincerely, y •627 z
- Q �Exppt'30-06
OF
Mike Nelson, PE,' �. CA `
. r
a 1 - 4r >
` F N ,• � • w L 4} �• - : • . ,• a 0�4 ..� -• .
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/
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24,, State of California, in the building located at:
"
50-410 VIA SERENIDAD , LOT 63, LA QUINTA, CALIFORNIA
-
CEILINGS:
%
TYPE:BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
.
y
TYPE : BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-21
e
e
GENE L O T CT t RJT ES LICENSE # 00
� y1
P N SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003