SFD (0011-301)79145 Mandarina
0011-301
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
690454.5 B WC •A
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•the.ir.sole
compensation, will do the work, and the structure isnot, 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. 7644, .Business & Professionals
Code).
O I am exempt under Section B&P.C. for this reason F
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 Py. 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
Se" dtion 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:
Cartier Policy NO.
STA1'F FUND i.iii 40E •t4" `
(This section need not be completed if the permit yaluation 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 ct to the workers' compensation provisions of.Section 3700 of the Labor.
Co , e, I shall forthwith comply with thos provisions.
D te: rb . 12 Applicant ? u
J.
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
thbove-mentioned property for inspection purposes.
4
Si nature (Owner/Agent) Date " "'1
o BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0fD'l.J.-' i'fA3, TRACT .
f ",e, ', 3 1 5 a;84
JOB SITE
ADDRESS
-
p .. 7'9-•14 lTi!Ai1iA
i 3:, Cati{ -d9i3
OWNNER
CONTRACTOR DESIGNER ENGINEER
✓ ] I4• 1' X74{ {✓ i4 .
PrqdWQWp1JM3,{'
PC) BOX 610
14.25 F, VNIV ?id I"' RNE
1Aquan.A CA 92253
KI0K1T5* . `AZ 850 4
((4.0257.1616 C'BL4 4990.:,
USE OF PERMIT _
WOL:ld FAMLYDAnT1i', I.:fIRTC
LX)T 33, 1TL4N MRQ. 'i3 PERMIT UOFX NOT INCLUDE HL OCK
W.it:l•,l,• 1 00€JW!)1zffW" APPROACH. 750/0 PLAN OLf.Lx* SE1W+°-nDi1a`3'It.?N
POR. A'tI31,TIPLE I ,SUANCE OF SSAMS k'.JAN TYPE.
CUSTOM, COWNSTRIUCT10N Zfsa 1Do OF
PORCHIPATIO 130.00 S
0ARAONCA)WORT (SlF) Ir, ,23,80
t
-r OF C0XfrfRVCwJ70J9
.s'ALTMU FEV 9UhVA i4y
OO1dS7RUCI'i'if;HIF 101-000,418.0013 %1,10mv
PLAN Ck1ECL,". RM 10'1-000- 39-318
;AQL:t.' Ai IIC: F. T I`b 1 O1 ^0(YJ '!'21 f C31? IU.5:ti0
.. .. l A 9f3C. b1.9 f3C3tp 51130,5
PLUMB-11HO PFX
STILUNd'a1MOTIt9N'M' .1 11MI-0 10-1--600-241-000 r
0FI:8',1 iAZC11 i 101-0MA-Z'k•000 $20,00.
DE'FI..00PI?,R IMPACT FZIE $7,W A 00
ART IN. PU'MIC PLACES -• R&011701 D(l0-355.090
EfUG °CtJ"I.AL. LONXI'R.t3M109AT3D 1✓'LAW C"1sW-CIC
S3,823.46
W PRE -PAID ] 138
$0.00
T M P3+'MM MS :OTTE A'ow
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
4 OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —
Underground Ducts
Forms & Footings [
Ducts
Slab Grade L
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 Voltage 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
FAX NO. :.76056,46505 _ Jul., , 25 2001 10: 08AM,- ,PT•
akh
:�i 4A,
. ,j
CITY OF LA OUINTA
`aoY0 BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUUEEXI�n
777'-715��
Owner RJT HOMES LLC'
Contractor
Permit Number 0011-301
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS
79-145 MANDARYNA
1 LOT 35 PLAN 3ARG. SFD PERI DOES NOT INCLUDE
BLOCKWALLS/POOLS/DRIVEWA,Y APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK Q • C7
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE -SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
�--(IOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
s '• ROUGH PLUMBING
ROUGH GAS & GAS TEST7.9- Q
HEATING & VENT- A/C
FIREPLACE
ROOF / 1
{ BOND BEAM
O.K. TO WRAP
GROUT G 4' 0 8'
FRAMING
INSULATION - d
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNER
t.AI LHIUI•I LAI rI
POOL PRE PLASTER
P,961<f ENCE & GATE
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST d
-ING - A/C
14OUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS 00 NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
J
Certificate of Occupancy
City of La Quin.ta
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 ADDRESS: 79-145 MANDARINA
Use Classification: SFD Bldg. Permit No.: 0011-301
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner pf Building: RJT INVESTMENTS INC
Building Official
Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 7-25-01
I POST IN A CONSPICUOUS .PLACE . I