SFD (0011-305)79105 Mandarina
0011-305
LICENSED CONTRACTOR DECLARATION
I hereby"affirm under penalty of perjury that l am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3`6f the "Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date ,
69003 . i TitC A.
N
Date " Signature of Contractor
-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). '.
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 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.
( l have and will maintain workers'`compensation insurance, as'required by
Section 3700 of -the Labor Code, for the performance of the work for whicfi this
permit is issued. My *workers' compensation insurance carrier & policy 'no. are:
Carrier Policy No. '
N` l.t 7:':L+ FUND.
(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
suN ect to the workers' compensation provisions of Section 3700 of the Labor
I de, I sh II -forthwith comply with those provisions?
ate: r" Applicant
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 fo 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 ayesult 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' r `t ' ' Date '--7
BUILDING RERMIT PERM T/1
DATE n VALUATION LOT 'I^ lha 'TRACT
.39
JOB SITE APN
ADDRESS
79•405 MAMAIMA 7724WAII-014
OWNER CONTRACTOR / DESIGNER / ENGINEER
PO BOX 81 t? 1425 B, ItJNIVE813.1.: Y DRTYE •
LA Q7.t; 'd t P:CA CA 9 233 PHOIIND," AZ 85034
'51M656 0-9x.111. .990
USE OF PERMIT
L T 59, PLAN "FAQ, SIM) PER1i IT Y.XX.S Nat rNCLUIZ 6
BLOCK WALL431POOLSIDRIVEWAY APPROACH. 75% Pf.,AW CHECK I -en
RY,DUC`, tft'yiEi FOR AMULT.I'PLE' ISS'dDA14CE OF SAW PXAAH3 E" y"'PK
a•
CUSTOM i':4&B'i'kiUC110N ` r,97A OF
B t dlr:4IlI A1IC3 ?1J3.00 SF
f3ARKOEfCARt°C. RT (SP) . . 11,4108.10
C:C9ST OF CC 3 ": !UMIO t
:2,144 . 40
p { y7p . y y 1 yi' T.TlaA'Y 1'
rg FEE
MOO
COM1'AUC.;TIONTilt
PLAIN C SXIC.1'If t
MUMMICI.AL.. E_ 101-000.421-000 $1II,aQ
ELEC` WCAL. F?8 101-0004120-000
'LUMBI O FEE 161 4000-4 i 9.00c9 -$t13Q.-So
Cli . ai:''IDSss31 ' • 1.01.e3±.ii 42 •.0b0 24 dafi
DEVELOPER IMPACT rFZ 00
ART IN i k'UBLIC I'Lr AES • US!C 701-000-255._000
r
3.=, IAL COMMi.R.0 MON AND P;lA4 ell03M
",69.3.43
LYES FRF PAM FM
$0.00
V DTA Lk-IMAMMS DUE HOW
$3.0 3A4
RECEIPT
DATE %
BY
DATE FINALED
INSPECTOR
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Hacks
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 ••46
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)
FROM RJT_HOMES FAX NO. 7605646505 s, yJul. 17 2001 12:43PM P1
_ Pa_
CITY OF LA QUINTA
� - y BUILDING & SAFETY DEPARTMENT
8M 0k7 777-7012
- INSPECTION REQUEST LINE
777-7153
Owner RJT HOMES LLC
Cantrector
Permit Number 0011-3051
r
POST ON JOB IN COMSPICUOUS PLACE ,•
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-105 MANDA NA,
LOT 39 PLAN 2AG SFA DOES NOT INCLUDE
BLOCICWALLS/POOL/DRIVEWAY APPROACH i
• 1
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
' FOOTING STEEL '
MAIN GROUND SYSTEM
GROUND PLUMBING7-10 Q
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L•. NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS SEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH ,
POOR PRE PLASTER
PPQL FENCE & GATE
EW SEPTIC TANK
FINALS
ELECTRICAL
TING • A/C
-•• SE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING '
'Certificate ofOcqupancy,
City :of La Quinta
Bu-ilding and Safety Dep'artment
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances •
of- the City regulating building construction or use. For the fol%wing:
BUILDING ADDRESS: 79-105 MANDARINA
Use Classification: SFD Bldg. Permit No.: 0011-305
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC Address: 1425 E UNIVERSITY DR,
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 7-17-01
Building Official _
POST IN A CONSPICUOUS PLACE