SFD (0011-298)79175 Mandarina
0011-298
/ . 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
X90645 . B 19C A
ate. Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that t am exempt from the Contractor's
License Law for the following reason:
(.) I, as owner of the property, or my employees with, wages as1heir sole
compensation, will do the work, and the structure is not 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. 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.
NI have and will maintain workers' compensation insurance, as required by
S4tlon 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 ' . Policy No.
ST,ATE'FUN 3Si Sir -i .
(This section need not be completed if the,pennit, valuation is for $100.00 or less).
O 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 worke'rs' compensation, provisions of'Section•3700 of the Labor
Code, I;shal forthwith comply with those provisions
vDate: f 1. _.C , Applicant—
Warning:
pplicant
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
constyuction, and hereby authorize representatives of this City to enter upon
the bove-mentioned property for inspection purposes.
Slgnature (Owner/Agent) ' -'' 19 t-' r tsl Date' r'' '"
t BUILDING PERMIT PERMT#
IVALUATION LOT'S Y 4D TRACT
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JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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I..AQl'JIVrA CA 922S.1
PROYNIX AZ 85034
(60Z)257-1656 C;i IAO, 49990
USE OF PERMIT
.LOT .U, PI..t3N 280. SM PEMMIT 00,93 ]V('I' I3 :L:YFl7' ; EIt,C3 lir.
,s tis lf :tl f ' 1 '1 i; l : x ' 'X ' A i• .
CUSTOM COWT,}bUCTION zmn ap
POP,ChVPATI+ Q3,CsU t;l
CONSTRUCTION FRE 101w0064119,_000 $1,94-2;00
i..o .'N i:ta a . 11 3 UI •0ff4• 3 I a t:k $fiS"iP. ;
,
MUCMKICA1. P* 1 4*00 i11.S4
1.01-000.420-00b $1593A
't+P.Ull,DR40 FEE 101,0609419-000 SIMM
ST90NO te9OTIDN M RE31D 101.000 -?x91-000 WAP
flhR/t<DMO FRE 101-000y423-000 ✓3.tib
iMVN>,Ls. PEM, PUPAVIT PEZ': $l,lif9 .QO
ART IN PiSBU0 P.)ACRO - RUIE 701-000 -255-000 SAW.:,
9iM-W7".tt L CON RM UC"tIC'1hT.f WD PIA4 4 (9.E,9T=X%,
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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
- U
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
- /. Cj
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final_
Final 7- U c 6 1C
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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) G
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 p
Utility Notice (Perm)
COMMENTS:
Certificate of Occu''pancy
City of La Quinta'
Building and Safety Department. V OF Teti
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:
Use Classification: SFD
Occupancy Group: R3
79-175 MANDARINA
Bldg. Permit No.: 0011-298
Type'of Construction: VN Land Use Zone: RL
Owner -of Building:. RJT INVESTMENTS INC
"7 dt.1
Building Official
Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 6-7-01
POST IN A CONSPICUOUS PLACE
FROM RJT--HOMES FAX NO. 7605646505 Jun. 08 2001 05:05AM PI
I
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING
INSULATION
sl
PRE -ROOF
. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH V.
POOL PRE PLASTER
POO_LFENCE & GATE
#EER 1EPTIC TAR
ELECTRICAL
PLUMBING
_FINAL GAS TEST
:nNG-A(C
J40USE -NUMBERS
JOS-COMPLETED...
FINALS _
1-5
1 4j
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
CITY OF LA QUINTA
ce BUILDING & SAFETY DEPARTMENT
OF
M-7012
INSPECTION REQUEST LINE
777-7153
Owner RJT HOMES LLC
contractor—JUT MVESTMENTrl) 2non
Permit Number' 0011-298
.. .
""""POST' ON JOB IN CO1q0P%CU0lLlM%jq6-,
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-175 NUNDARINA
LOT 32 PLAN 2BG SPD PERART DOES NOT INCLUDE
BLOCMALLS/POOLS/DRIVIEWAY APPROACH
TYPE OF INSPECTION DATE INSP,
FOUNDATION & SETBACK
FOOTING STEEL
"N GROUND SYSTEM
GROUND PLUMBING GQ
PRE-GUNITE
00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
3514CHM SLAB- - i
JOISTS& GIRDERS
ELECTRICAL GROUNDWORK
NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING -&-VENT- A/C.
FIREPLACE
.....
ROOF
I
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING
INSULATION
sl
PRE -ROOF
. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH V.
POOL PRE PLASTER
POO_LFENCE & GATE
#EER 1EPTIC TAR
ELECTRICAL
PLUMBING
_FINAL GAS TEST
:nNG-A(C
J40USE -NUMBERS
JOS-COMPLETED...
FINALS _
1-5
1 4j
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING