SFD (0011-303)79125 Mandarina
0011-303
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.
Li nse # Lic. Class Exp. Date
690645 We A 00,3,04
Signature of Contractor `r •✓
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 isnot 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:
O 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided.for by Section 3700 of the. Labor Cocle,"for the
performance of the work for which this permit is. issued.
I have and will maintain workers' compensation insurance, as required by
Section 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:
Carver ' Policy No .::
STApE`lF(fAit?`
(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 th Se provisions.'
106ate: I 'Applicant
J:
Warning: Failure to secure Workers' Compensation coverage is unlawful and
,shall subject an employerto criminal penalties and civil fines up,fo,$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 restrictiohs 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 hull. 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
th °above-mentioned property for inspection purposes.
Signature (Owner/Agent) f r Date
BUILDING PERMIT PERMIT"
DATE ! / r VALUATION LOT 0011-301 TRACT
JOB SITE ]APN
ADDRESS
7 -5." 3 .1 A3xt'gA 'A
772-C3 4M04
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RH FIONES I.> '. '
^R37, rwwrwws, INC.
-I
PQ T:IOX"810
3425 X U3 %; 1° tM!: T DRIVE
LA QbWVA, - CA , 92253
. PHOM ',:..: - " AZ 850.14.
t'
< 0257T15Ea3 di 49 0..
USE OF PERMIT r
91N 01-E FAMILY'DW.f J.al: 4
Fb i ,T-•RPAnk ..1yoAn N07 04CLUM? a3..i sex
i1VAL,L:SA'00%MI1,iVr,,W,AY A,PPROAt't!'i, '75% PLAN CH -K RX WMK`! ION
FOR 3!9"QLTIPIX IS IIFANCE T'`I PY.•
CUSTOM COD3aTFLUMo t ON' %nno PF
P£7I C 1 7Irf1'; $t l 20 : tt4t SY
0ARAC RiC'AI'{. ORT M,' 11.41M`29
ON
214,0556AD
FFAXVF F M" SUMMARY
C al,18TRUCT101T 1 "kLe 101 -VOID -41 8-000 $1,042,00
PLAN CHIZICIC FF 101-000-439-.318 3 0214.47,
MFIC1J"ic'.1hilYBE 101.000.421,.0001 $11I150
ELfM'T't'MAL FF.Z V59.0
.C.CI349 k33tdc 3 1? 101-t 00.4 19-000
STRONG MI I$ FEZ : MID 101-000-241-000
0RAD1140 FER. 101 -004123-00X) 2t1,it
b'lMIA)P1I A. 3 AIIPArT FRE $ i,90y, Ott
AWT IN PUBLIC PLA.CM - M11 +5.-000
E, 'M, -': 0TAI's - 1014ti' Yt.Uff, f109 AM P C3'J-E4I.:
$3,693.44
IBM PRE D FEES
$0.00
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` �2� Q _
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 Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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 Plaster
Sewer Lateral drAPool
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
V
Final
Utility Notice (Perm)
COMMENTS:
FROM FAX NO. 7605642238 Jun. 25 2001 10:22AM P1
o
CITY OF LA QUINTA
AlAd
BUILDING & SAFETY DEPARTMENT
F, - 777-7012
INSPECTION REQUFSI '
777-71 6 d ° Y
Owner RJT HOMES LLC DEC • r . ZOGO -g
Contractor RJT fNVESTMWi"
Permit Number 0011-303
POST ON JOB IN CONSPICUOUS PUCE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS .79-125 MANDARINA
LOT ALAN 213G SFD DOES NOT INCLUDE
BLOCKWALLS/PO01MRT'VEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING -
PRE-GUNITE
DQ NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK ,
U. NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC "
ROUGH DUMBING "'
ROUGH GAS & GAS TEST
HEATING'& VENT= AIC
FIREPLACE
ROOF 76,
BOND BEAM
O.K. TO WRAP
GROUT 0.4' DO'.
FRAMING
INSULATION
PRE-ROOF ""
COVER NO WORK UNTIL ASQYE HAS BEEN SIGNED
DRYWALL INTERIOR 1
EXTERIOR LATH (
POOL PRE PLASTER
L FENCE & GATE
EWEn SEPTIC TANK
ELECTRICAL
PLUMBING
FINAL GAS TEST
• i1Nf3'•'A•/C
HOUSE NUMBEF
JOB COMPLETE
TEMP POWER
FINALS T' '
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
i
Certificate of Occupancy
City of La Quinta
Building and Safety Department
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
ollowing:BUILDING ADDRESS: 79-125 MANDARINA
Use Classification: SFD Bldg. "Permit No.: 0011-303
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: 6-25-01
Building Official
POST IN A CONSPICUOUS PLACE