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SFD (0101-009)79085 Mandarina 0101-009 F. LICENSED CONTRACTOR DECLARATION U) DECLAR-ATIO N,, .. i' I hereby affirm urjerpenaltyof§ejyry!hat 1am.lici=i d ynq: prbvisiorsof. chaoter9'(commencing with' Se6tidn-.7000)Fof Division3 of the Busin - e ss and C14UQrofq)ssionals Code, and my License is in full force and effect. L:D 1.-;6•1'1:lcense # Lic. Class Exp. Date Cy LLI Signature of Cor &Z r_ Date Contractor 0 I.– C), OWNER -BUILDER DECLARATION/ LU ui I hereby affirm under penalty of perjury that I am exempt from the Contractor's 1 7 a. U) License Law for the following reason: Z 1, as owner of the property, or my employees witt,: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. 7644, Business & Professionals Code). co N I am exempt under Section B&P.C. for this reason 04 Date Signature of'Owner.; 0, N CY) CL < WORKER'S COMPENSATIOWDECLARATION Z 1 hereby affirm under penalty of perjury one ,of the following decla'rations: 0 CC ( -) 1 have and will maintain a certificate of consent to self -insure for workers' .X. LU compensation, as provided for by Section 113700, of the Labor Code, for, .the 0. _J performance of the work for which this permit, is issued. 1'have and will maintain workers' c'omp6nsation insurance, as required by '0 QSection 3700 of the Labor Code; for the performance of the work for which this Lo permit is issued: My workers' compensation insurance carrier & policy no. are:, It Z Carrier. Policy No.. ,00 STATE MID 0 < (This section need not.be completed if the permit valuation is for $100.00 or less). _J 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 4Subject to the workers' compensation provisions of Section 3700 of the Labor Code,, I shall forthwith comply with those provisions. Date-' Applicant— 'Warning: Failure tosecureWorkers' 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 I work is not commenced within 180 days I ' rorn date o i f issuance of such permit, or cessation of work for 180 days will.subject permit to cancellation. l.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 propefty for inspection purposes. • Signature (Owneir/Agenti;,_/. Dat6k_ BUILDING PERMIT PERM T# P. DATE VALUATION LOT 010J..0W TRACT 4 '2R447 JOB SITE ADDRESS APN J . ,I Mffj AIANDARMA 712, 0 CO 4 OWNER" CONTRACTOR t DESIGNER EN PO XWX 810% 1423X CA 9.1,1253 PROMIX, AZ 85034 (=)25746% 013UP 4990 USE OF PERMIT MIME RNIAMY DVIELLMO SVD-PLANIRA LOVI.P.21RUIT M%SNI& 04CLUDr. ACH sr SP 0ARAOFICARPORT (0,F) 11,328,80 Fsaw:1-0 Con Ole consumanaff 233,748.,'R) suh"Ry COASTRUCT1011 FEE 101-000-416.000 a1,108,50 'PLAN CHEM', RX 101­00 439-31-8 $006,01 MECIRAHICIAL 1w, 101.000-12,11-000 S.1n.00 ELFICTRICIA], PF"KIP 1,D) -000,120-000 $168:22 1 PIX510,R)"No ME SISO,50 STROM MOV014 F",- RES31D 101-0-00-241-000 Ply/ ORADYNO FIR 1011-000-423-000 00160 D M 11, 1 X) P, L? R. I M P A CT ``12P I'Dw. 0o ART 134 pugue PI.Apol Kagr 701 -000.255awo $94M SU, 4 AL CONZOMIX-MICYN Amy PLA W CW WX $4,502.97 LSM PRE­PA[S)FKtW_S_, 16rm M m -'s D -ur Now I a V Q97 '% A RECEIPTDATE BY DATE FIN4ED INSPECTOR INSPECTION RECORD �. OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR f BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel 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 Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 Piaster 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) „• fns 0 Y OF LA QUINTA s AhWIS & 6AFETY DEPARTMENT cs or y JAN 0 9 2001 777-7012 NSP40%7-7153 REQUEST LINE AT Y yr Owner RJT HOMES LLC Contractor RjT INVESTMENTS INC Permit Number 0101-009 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 79-085 MANDARINA SFD-PLAN:3RA LOT;4I-PERMIT DOES NOT INCLUDE SLOCKWALLSIPOOWllRIVEWA'Y APPROACH. TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB % • . + ( JOISTS & GIRDERS ELECTRICAL GROUND WORK C JOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST - HEATING & VENT - A/C FIREPLACE ROOF / GL BOND BEAM O,K, TO WRAP GROUT 0 4' © 8' FRAMING INSULATION PRE -ROOF - COVER NO WORK UNTIL ABOV15 HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH (• POOL PRE PLASTER POOL FENCE & GATE $EWEFtSEPTIC TANK FINALS ELECTRICAL PLUMBING i FINAL GAS TEST - rf 2— L'r .. wG A/C E NUw1EJERS JOS COMPLETED ETED TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING Z0 39dd S3WOH ifN 9099V9S09L 8S:80 Z00Z/50/tV0