SFD (0011-302)79135 Mandarina
0011-302
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 ,^t
690645 BMC! SFA j/. 06131101/2CV/2
Date' ` • Signature. of Contractor V
OWNER -BUILDER DECLARATION t `.
I hereby affirm under penalty of perjury that I am exempt from the. Contractor's
License Law forthe 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 & Prof essionals'Code). '
( ) I, as owner of the property, am exclusively contracting with licensed
contractors. to construct the project (Sec. 7044, Business & Professionals
Code). /
() I am exempt under Sectiori 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`.
C ) I have'and will maintain a certificate of consent to self -insure for workers'
compensation,- as provided for by Section 37.00. 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
Section 3700 of the Labor Code; for the performance of the work for which -this
permit Js issued -.,M9, workers" compensation insurance'carrier & policy no. are:
Carrier -Polity No.
STATE FUND " 133 0$•ti0
(This section neednot 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 -is sued'.
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
S 15ect to the workers' compensation provisions of Section.3700•of the Labor
I shall forthwith comply withahose provislons..e
v ate: . %.f%y. 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 3708
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 '9n 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. l agree to comply with all City, and State'laws relating to the building
co struction, and hereby authorize representatives of this City'to enter Upon
th6above-mentioned property,for ins ection purposes '
Signature (Owner/Agent) r j,,, 1 IoG'Z,Date
BUILDING PERMIT PERMIT"
TION LOT TRACT
DATE /'w2 v4k___
dd I { [11q 7
.- OJ41 . W {: w 2ir-e 7
JOB SITE VAPN
ADDRESS iT. 1J'- .. s .i .i I .
1 ••
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PO DOX 810,
3425 V-13121TIVITIA-UM."DRIVE
.(602)257-1656- =41 4998
USE OF PERMIT
I.,0T A ''PLAN R' 0: SM PERMIT I7a.C,S NOT INCLUDE 01,o k.
IYOR MU1.11t LY, ISSUANCE OF SAME PLAN TYPE,
CUSTOM CONS' TUI TION 7.,833,00 %
taORC". ATIO
, RAOUC ,.RisOR, I (Sf) 1113-20.90
233,M60
PERbM.FFE SUMMARY Y
CONSTRUCTIONFF-131 t101 -0,00-4-18-M) SLI08,50 .
.
PUN Ctaf ICK t
MECHANICAL FEE, i 7 aL t3a 121 3ltt"I.t O
P:LfrCTf2IC:.AL t Pr. 9 t47 -t^W- 420-000 ICtE.
1itUMMA() Mg I W wW-41;4.000
STRONG MoT110H FEE • RESID 101-000-7141-000 $33.37
t 1t"ti'ii ITICIF C : .. 41 CI 4tI r7tiat1Ct9 .$ f :OCf
.
TXV1tJ OPER IMPACT FXR .1,9LY3 alp
.ART IN .PUBLIC PLACES w RESIE 701-000-255.000 .. 0437:
I S FRE -PAM "M
S0.00
RECEIPT DATE , J BYC. j' . DATE FINA LED INSPECTOR
INSPECTION RECORD r.
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
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
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 VoRage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
FROM RJT_HOMES
-a
LLL%
FAX NO. 7605646505 Oct. 17 2001f09:30AM P1'
0 i
. w CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE r'
777-7
Owner RJT HOMES LLC :-
S: J
contractor RJT EWES'TMENTS INC-
Pwr1. A ra 400
01 3 4v f Vl IW f
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-1.35 MA"ARINA
LOT 36 PLAN 3BRG SFO GOES NOT .INCLUDE
BLOCKWALLS/POOL/DRI'VEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK • 0
FOOTING STEEL -
MAIN -GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB Ci
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
6. 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
- D
GROUT. 0 4' O S'
FRAMING
of
INSULATION
PRE -ROOF
m
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
F NCE & GATE
SEWER 13 EPTIC TANK
FI
PLUMBING
FINAL GAS TEST
I NG - A/C
A00SE NUMBERS " ')
JOB COMPLETED
TEMP POWER CC ZJ
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING 2 '
I