SFD (0011-299)79165 Mandarina
0011-299
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
690645 11110 A" 0 M10/71t
-,J, ate % - "- 7"'✓ Signature of Contractor f'-• L I IAF.
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 ofthe 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).
(
J. 1, -as owner of the property; am exclusively contracting with licensed
contractors to construct the project (Sec. 70441 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:
O 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
Section 3700 of the Labor Code, for the perfornmance-of the work for which this
permit is issued. My workers' compensation insurance carrier• & policy no. are:
Carrier Policy No..
(This section need not be completed if the permit valuation. is for $100.00. or,less).
. (.) I certify that in the performance of the wor0or 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
subj6ect to the workers' compensation provisions of Section 3700.9f the Labor
Conde, I shall forthwith comply with those provisions.
gate: ! "l .. - . Applicant , -j r' : , t .
Warning: Failure to secure Workers' Compensation coverageJs, 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 agreesto, &•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 ove-mentioned property for inspection purposes.
Signature (Owner/Agent) 'r ^^ f- . ?'' Date
-
BUILDING PERMIT PERMIT#
s
DATE VALUATIONry y */ LOT . ^•: 'SI TRACT .
y/ 28(4•
JOB SITE
APN
ADDRESS
772-0604i'ZM
OWNER
CONTRACTOR / DESIGNER / ENGINEER
eP? i iD
X142-5 17.UNIV.'`RMffb'Rin.
LA QUIN)`A, CA 92253
PHMUx ' AZ 850:34
tt<stY o DT* 49-90
USE OF PERMIT
SING
WT 53, P1.JVN 38P'.C. Sm PPRMI.T b0it :N01 ' 1rk.BAIL?'8? HL OCX
WAL,LWPOt5k,. A)ktI WKWAY A.PPROA.OK 7S%, PLAN Ck IrWX Yf'~k:.l H-DUC'f ION
1VCi.91:1I>!l.UL 1041% IS°Iti.b tdt E OF ISAW PIAN TYPE
CUSTOM CONSTRUCTION' 3TION' 4333.09 Sp
PO'wmiAf;.A`I Io 1301838 SF
QARAC3t• /0A.t2P0PLT ( 3 t 323,t dt
] e ',tIM COSI, tyle' (1164i'I`LIR C:'"C C7N '
,' . 74itdANCJ
Ca? '!' 3. .1C.'p'I ?d:'t<'. . • jr .,0igd r] FK. {i a, p,c , '+
PLAN CHECK MY. 101 -000 -43!P -?,18
MECHAMUil, "M 10 1 -000-411 -000
l 1,i )' t,JC,.Etr.. 'Cr ,' •< _ 10=D- 17C4- w(}-83fJt $16 .ae
,
P3.i3mF1ai0":!? 101 -000-419-000 1 p.383
S TR O y at )/Myy Taa ION F.F, - PM,011^ 161-000-2411-000
p,{/
'Nlti.ADR4OL"i.E L "'<+ V" fi l,•'y {.7. 6Ve4 V.
..
OL LOPL P A4 PACT FES'
ART T14 PUBLIC PLA.S:`&S-,1ZESiE 701•ii sf3» B i'.G1 U' Ah,3`1
7f3-'?G`C)fAL C0 9TRUCTU_ON AND PLM .Iw"U.
$3,923.46
't YE pi,14'-WIffi":t=1000 DUE NOW
RECEIPT
DATE} `•B d
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE I
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 —(f
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.Q.
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 r
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
SewerLateral
Pool Covet
ewe Conriection - _
Encapsulation
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 Aug. 15 2001 08:47AM P2
6
- CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
',; .ok...... 777-7012
INSPECTION REQUEST LINE
777-7153
Owner RJT HOMES LLC
Contractor
Permit Number DOX1-299U
POST ON JOB IN CONSPICUOUS ICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-165 AIANDAYtYN'A
? £`: LOT 33-PLAN3BRG SM PE IAIT DORS NOT INCLUDE
DLOCKWALLS/POOLS/DRIVEWAY APPROACH
TYPE OF INSPECnN DATE INSP.
FOUNDATION & SETBACKfA-
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING p
PRE-GUNITE :
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOIS7;3.&. GI,ADERS `•
ELECTRICAL GROUND WORK
L;y-oIOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A!C
FIREPLACE
ROOF 5 1
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' 081
FRAMING
INSULATION Y.2d
PRE-ROOF
COVER NO WORK UNTIL ABOVE H S BEEN SIGNED
DRYWALL INTERIOR (77
EXTERIOR LATH
POOL PRE PLASTER
POOL ENCS & GATE
E SEPTIC TANK
FINALS
ELECTRICAL } Cf
PLUMBING
F1dPL GAS TEST
ING - A/C
WdOSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITI ES OR OCCUPY BUILDING
Certificate of Occupancy
City of La Quinta
Building and Safety Department, c o:ti
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: 79-165 MANDARINA
Use Classification: SFD Bldg. Permit No.: 0011-299
Occupancy Group. R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC Address: '1425 E UNIVERSITY DR
Building Official
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 8-15-01
I POST IN A CONSPICUOUS PLACE