SFD (0011-304)79115 Mandarina
0011-304
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
6apter,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
ate =2' ;7 -ee, 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).
( ) .1, 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.'
I have and will maintain workers', compensation insurance, as required by
6dti6n 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 87ATE FUN, ' . Policy No. 1 3a 6'• 9
(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
suY!ect to the workers' compensation'provisions of Section 3700 of the Labor
Code, I shall forthwith -comply with _those' provisions
.
.•
yVate:' I -• — .•n -c% -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 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.
,S nature (Owner/Agent) '`r ' # `'t Date 42
.j X
BUILDING PERMIT PERMIT#
DATE . VALUATION LOT WILI-309. TRACT
2,6457
JOB SITE
ADDRESS
APN
79-1 A 5 M: iND,+=A
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RX171ROWS T.W.-
"M. D4101
K) 843.E 810.
142.31H, D1T1Y1:1_!1TY 1M
LA QU'WfA CA), 97753fxC'
MIX .ice M034
M4 -'49.00
USE
(OFPERMIT { Q /9 d/
NJJ.I.l14: JYM.L, F .I.®. ffl sJ i :i'.L4,fFilJ+7•i,
14IT 3PL1NARCIL norm ; w Au'wLwjbrBTC)fK
VAlUL?)sIDRtl..'.A .pPPFI.O:AffC, aPLAN Cl1M 1E 6Er7yY.ON
FSlit. li!'iill,'I'1PUe 1SSU,04C.& OF 3Fi V, P:LAN *TYPE.
CUMM CONSTRUCTION 1,933.00 8F
P0P.C1jft,1AT10,: 5?
MMIT.°. ' Com' OF CONST S'!MMON.7
F'7+"._ . .
CONSTRUCTION YE.9 1.01-0 :t0- 41F ,'400 - "' $iM1Dt't `, Q1
PI.,J H CH1+aC K F& i 2't-(1oO43t '3' 1:6
011 C'.i RIC;J's;L-PE R1 t 21.,t11t • 20: (j $ i 5 : E3
MUM1 DIC "Qu iO`I 400-419-000 $180,50
STRONG MOA70M FLT': w IM11) 101-000-2,11-000 a 333.37
ok.Att9ax0115 yF LySfp? l o l vw -423 -000
y 1$20.600
7 7: '1 :F✓Yf .'9.0 d F Jittll-Fi1,.• l A i'.•.SC+ .. - K/ ,fiplJ %. V.iF
ART M PUDLIC1'I.ACM IIE.Sii1:701<=(IiJQ-ZS:5-WU
'
r..
W13 -TOTAL TAL L"t 1 1.IYTi °,11i: H : ,'t 1D PT" al-V3101K
$3,823A6
ISS P'T -PAiA) P10.1`:
$0.00
•'
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RECEIPT
DATEp
BY l
DATE FINALED L
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
_ Q (
Compressor
Insulation
i
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
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
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
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
FROM FAX NO. 7605642238 Jun. 26 2001 09:27AM P1
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it
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BUiL'b"ING;SAFETV'DEPART
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•;;;;I SP.ECTIO,N REQUEST LINE*741
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0011.-3. fi
pwinit Nurl>bl�t S PLACE
: ;POST` N°,JO ;iN yGONSPtC000
INSPECTOR'°MUgTiSIGN:ALL -ApPI:lCASLE SPACES
>: JOBADORESS"'
• '' � ' �I.Ux' PLAN G:SFA DOES NOTINdLUIDE
6I R' JVEWAY APPROACH
.TYPE"OF�INBPECTIO(V: , . .
FOUNDATION&36T8ACK'';K,�'
MAIN GROUND SYSTEM " f •, ..:: •:<::
.. GROUND -PLUMBING t
:<•
<' DO: NOT'POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED'
CONCRETES.LABi `� ;
J013T APIRDERS:l.i...>:'.:y;•:.. ... t;,..;':
ELECTRICAL GROUND WORK77
[svvrIOT:POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED k ;;:; ;t.
ROUGH ELECTRIC „>, .,�,
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST `L s
HEATING BVENT -A/C '
t' FIREPLACE
ROOF: 267
BOND BEAM
O.K: TO WRAP - O`.
GROUT 0 4' .❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK NTIL'ABO_U HAS BEEN SIGNED •s';`'> `
'
DRYWALL INTERIOR '
EXTERIOR LATH
POOL PRE PLASTER
L FENCE 8 GATE
ISEWSEPTIC TANK • I_j__
•,7. ..... ,.�. .. . _ '.FINALS • �;;.::.;,s::»' •
ELECTRICAL; a "'
PLUMBING'" (,
FIN
SE'NUMBERS::--
` JOB COMPLETED..
TEMP POWER':.?.e;_,;:r,;,,;:
A80NE.`gPPROVAL$ DO NOT INCL D -,.TO.
U E RIGH
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Ce-rtificate
of 1:0j,
.
UltyoIlLaQuirta
Building and Safety Department cF,koF,
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 following:
BUILDING- ADDRESS: - 79-1 15' MANDARINA `
Use Classification: SFD Bldg. Permit.No.:. 0011-304
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: 6-26-01
Building Official
POST IN A CONSPICUOUS PLACE