0401-123 (SFD)License #
ACTOR DECLARATION .
/ry_tliat I am_licen'sed under_ provisions of
i;700
of Division 3 of the Business and
Is in full force and effect.
Lic. Class Exp. Date
dJ.70 ^Y� L .Luc .4 B 6/30/04
Date k T' J4 Signature of Contractor "k"
s f
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 & Prof essionals.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
5 Z .I hereby affirm under penalty of perjury one, of the following declarations:
O () 1 have and will maintain a certificate of consentto self -insure for workers'
W L 'compensation, as provided for by Section 3700 of the Labor, Code,. .for. the,
J Q performance of the work for which this permit is issued.
Q U ( ) I have and will maintain workers' compensation insurance, as required by
U QSection 3700 of the Labor Code, for the performance of the work for which this
U-) H permit is issued. My workers' compensation insurance carrier & policy no. are:
z Carrier STATS FI. ND Policy No. 150906-01
co 5
P_ 0
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
µ'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. Ere
J�,Date: %-+I'.,�i:!f Applicant 2 �rf� �. ( 1.`> G
V b r
i Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
' correct. I agree to comply with all City,' and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) - `� %' t�9 !. t �ti'.� Date
61
.T . BUIL ING PERMIT PERMIT# ,.
04 01-123 �`
TRACT 98
DATE' VALUATION LOT 216 513-7.
!
JOB SITE
APN
�l�qh ��q/•�n 7� y�/�
ADDRESS r19 -LW— ArXA- SIN C U.aAs1�iDO
^y te !•,
. 72,37 •" 16
OWNER
CONTRACTOR 7DESIGNER/EN 1NEER
IDd1C�Vtfls q.0
R 3 lwESsTYarm yc"
PO BOX 910
1425 r ti?WOMIT7°Y rM:)? . .
"+LAQ='TA, CA _92253 •
iET010'Dc- AZ 85014
-_
- (602)2"? -1656 GG19 4990
USE OF PERMIT i
'e�.1dY1.9d��1's'1GP.i.+-t-�~�'.Ad VY.L..Lr9.ettvV
SM!, l OT,25, PLAN SFZAC2. PERU AM' 1,1OEM t OT 22,1CLUDE POOL,
OR& 11 LUCK V1 AU.x1, OR DRiV:iWAY.PXP1'OAC H
TRACT CONSTRUCTION SP
PC3X�Q',3�11P,+�'Pla�9' 9l1kkF0 S�d�'
(MRAMICARPCiRT 724.00 Te
ESUMA$ V-0 C:O19,T C'1'-CONFAU3IG 014
263,1..' , .
CC1`•1fwTRUC 71914 PEE 101.000.418.000 $1,22 9,617
PLAN CHECK. trE
N[ .011ANIC.ALFaE 101-000.421.000 Sa159,00
kELEC;'I PUC AL ME 1101-000-420-000 UA9.72
PiAlbAi'II• a FETA - 101.000-419-000 =00
tea' MZO A40TIOR FPC a RESID 1011 -000 -VI -000 $26.31
OR&DINO Mr. ; . 101.000-423ti000 SUN
DEV'E'LOP.Ek MOP:r1C'! FEE $2,405.00
M PLACES - RESIL 270-000-445-000 1 V:85
.MU(, ON AXP,SP1:.�'�y2y���t"'�1pBpr"�I� .
P)5,531.21
JAN 2 2004
CIT7f OP LAQU11+YA
FINANCE DEPT.
RECEIPT
DATE
BY..
DATE FINALED
INSPECTO
F
Z, f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
3 - 2 - y 'c
3 -,_22 -- y .J7
Ducts
Return Air
Steel
3 - 1,,.2 - ./
Combustion Air
Roof Deck
-
Exhaust Fans
O.K to Wrap
- —
F.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
Drywall - Int. Lath
-
Finalzog
Final - - 5
BLOCKWALL APPROVALS
POOLS -SPAS
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
Seaver Connection
-
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 6, // - Y
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors Eli z
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTSV�tWb� `f//j�y s
i�!i . �i �!v 7� a . ',T :,�,�y 4i+_•r�Jiy!ti y
PS - 14712 SW Scholls Ferry Rd,
# 328 ,
of '„Beaverton, OR 97007
503-524-8268 #' \ • ; ,
503-213=6222 (fax) e {
' Y .' - .. , f • r t , _ ~. ' ' - ^ �•'_ •iwarm. r 'ti _ ' • _ • .
-. t ti • '_.s t'.= f� orf '.'o� .-•' ,•s _`��7.,. + • .
♦ .ter. '. _ js�``/ - •' - .
Chad,Me'yer,
r; RJT'Homes, LLC
: w .79700 50”' Ave'
r' LaQuinta, CA 92253 • . ,. ,_� u"
RE: Structural Observation - of 26 & 27.
y l Chad,' F
,., '
` ;Sample observations were made of the above houses to ascertain whether
Y - '`the general intent of the construction documents is being followed. With. { '
respect to the structuralitems that remain uncovered and.easily observable; }' �
this appears to be,the case,{witfi"no unresolved deficiencies remaining'that l
am aware of.-.,- . • * r .
+'J a ' ..� tt';• 1 ' +r'fi • i;t y F T .+, 4.5 . y -• ,. — '1 +r eY # -' ,
QPOFE nSIO
277 `+ .
Mike rNelson, PE. ` Cr EVvsr3
r ' q OF CA��F
I` it i .
CY'.
�0�_
--GCe,rtIT to of Ocic�unan
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.� - (� . ../ 4 � �. 4.1 '' 'U {� tRsr d4 • .n 4J Yea 7,
,. GOFY'T9� ` �ld�ng &Safety Department'Bu
.:,.'3 is Buildin •' y -
This~Certificatesis issued pursuant to the'requirements'of Section 109 oftthe Californ g .
Code, certifying ,that, �'at'+ they •time of 3�ssuance,, . this (structure = was m compliance. with :the y
provisions of the iBuilding,-Code. aiid >the�'warious` ordinances.° of 'the City regulating: building
�a construction and/or.:use'
� 1
N r
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BUILDING ADDRESS. 79-540MIA,SIN,C•UIDADO . -� r
S. D _ " _� h '� ' r 'Building Permit No.: 0401-123 E
Use classification. - ° J
r
Land' Use Zone •'R-L
Occupancy Group: R-3? _ �,y Type of Construction VIN
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Owner of Buildin :RJT HOMES
-LLC: ;i t` ` r;" - 'Address: PO'BOX.810 Y F
City, ST;rZIP. LAQUINTAXA 92253' �
By:''G.SHOWAL'TER
�-. - Date 02/1`1/05
Building Offlcl
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POST IN -A CONSPICUOUS-PLACE
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