SFD (0011-306)79095 Mandarina
0011-306
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
.• 'l i .$J' B1'9.1.0A y VLIlov
Signature of Contractors
I
OWNER -BUILDER DECLARATION
-
I hereby affirm under penalty of perjuy 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).
O 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.4 certificate of consent to self -insure for workers'
compensation, 'as provided for by -Section 3700 of:thelabor Code,"for the
performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
S ctfon 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.
(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.
/ate: /v1--1 -z Applicant Ve V 9 :- /
Warning: Failure to secure Workers' Compe Lion coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1.00,000; 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
thelabove-mentioned property for inspection purposes.
Signature (Owner/Agent) . / -{ } { > { • Date'
BUILDING PERMIT PERMIT#
t
DA E f VALUATION LOT . l ' • .)!.^,9HC1+6:1 TRACT ,. I
40 27
JOB SITE
APN
ADDRESS
79,,,093 MAKDA.MNA
'
OWNER'
CONTRACTOR / DESIGNER / ENGINEER
1
1:2,3'i H( At WI; L)L C t
;fd.Y7° nI"+dplur,li NTS, MCI
-Pp D 0 81(1. + .
1425 X 'QAVLeRs HT Y DWNL-
.(602)257-1656 .. CZW 4990 .
r
USE OF PERMIT f
S11J•( ul PAWly 3.9W.U. .AJC'r
K
LCYr 40, PLAN 3.8PQ, . SYD PERNI:C DORS NOT ftIC.LUDF, MOCK
"MAT X/POOLWIDRIYf?WAY APPROAM 75% FIIAN CHECK FES: Ri DUC11.014
FOR MULTHPIX ISSU.ANi"Z OF SAME PLAN T:??9,L
CUSTOM C:OAISIRUCTION 2„V4100 3F
PO CHWATIO' IX00 S'i''
.0A AOFICARPORT (St?i 11p 2G<.: t1
.E63.1.W^,.FA'.Mr COW Gellj COWMLi'vT1 ON
7} I4d1r_W -.
P1 tM,T T117 SUMMARY
C 01-ISI'PRIH4"T1014 FET .101-000-416-0001 000 slow'so
Pi:.&W CHEC:1.0 PFUIP
MECHANICAL, PEI? '101.000.4.21.000 LHp .Dll
RLRC'r1Li,".14LI FKIM 101,ril1H.0-4212-000
PHA)MV1114 H I lO1'i9t 41 £y'.Ht9 $.42fi.S(t
'STRONG MOTION PEir - a'&= 1017000.241-001). $25.37
ORADINO 701 101-000423.000 $:d0,ii0
D 1,LOPER IMPACT. FR $1;30 00
d3 ,'r IN .Pi OLIO I'H AC'> 8 - UK 701.0.tics-256. 00
XX v -PAID, IWB
MOD
IXY A L 41Mt310OZES 1Y17,IJ< Mw
RECEIPT
DATE j }
BY l
DATE FINALED
INSPECTOR
. Ivl J
r C. rf
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines — /
Gas Test
Electric Final
Heater Final
_
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral _
Pool Cover.
ewer 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)
FROM :
FAX NO.
7605642238 Dec
03 2001 11:49AM P2
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
777.7012
INSPECTION REQUEST LINE
7777153
Owner RJT HOMES LLC
Contractor. RTT iNYESIMEN&SaW
Permit Number 0011-306
POST ON JOB IN PS1.SiP CE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-095 MANDAIUNA
LOT 40 PLAN 3ORG SFD DOES NOT INCLUDE
BLOCKWAL>LS/POOL/DRtVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK O
FOOTING STEEL !
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GI)NITE .
00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIG ED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L— r4OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT • A/C
• w
O.K.•
—.W0
COVER NO WORK UNTIL ABOV HAS BEEN SIGNEn
DRYWALL INTERIOR
EXTERIOR LATH +
POOL PRE PLASTER
PPQL,FENCE&GATE
$EWEP SEPTIC TANK l
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
w
i:•
FAX NO.
7605642238 Dec
03 2001 11:49AM P2
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
777.7012
INSPECTION REQUEST LINE
7777153
Owner RJT HOMES LLC
Contractor. RTT iNYESIMEN&SaW
Permit Number 0011-306
POST ON JOB IN PS1.SiP CE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-095 MANDAIUNA
LOT 40 PLAN 3ORG SFD DOES NOT INCLUDE
BLOCKWAL>LS/POOL/DRtVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK O
FOOTING STEEL !
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GI)NITE .
00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIG ED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L— r4OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT • A/C
• w
O.K.•
—.W0
COVER NO WORK UNTIL ABOV HAS BEEN SIGNEn
DRYWALL INTERIOR
EXTERIOR LATH +
POOL PRE PLASTER
PPQL,FENCE&GATE
$EWEP SEPTIC TANK l
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
w