SFD (0008-201)79195 Mandarina
0008-201
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
B 1=1 A,, W30/2f.
rA,
Date " "' Signature of Contractor ..i , Y
tJ
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 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 & Professio"nals
Code). - 1,
4
( ) 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,provid'ed 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 performance of the work for which this
permit is issued. My workers'' compensation insurance carrier & policy no. are:
Carrier INS, COMPANY OFT Policy No. V4DF,470041900
(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 those rovisions.
Date: 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 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
the above-mentioned property for inspection purposes. !
Signature (Owner/Agent,_ Date 1 7y
BUILDING PERMIT w PERMIT#
DAT. VALUATION f i• LOT: CO01 TRACT
ko,
JOB SITE
ADDRESS 79I,V A
APN
OWNER !
CONTRACTOR / DESIGNER / EN (NEER
R.11T iqI M R+SEt'A3VS, WC-
1xrr hgV1;a1`Jv"JM; DIC:.
142-5 Z ilWMZM .DRTV"L
14251& 'UNMRUffY DRNE:
P I41 J1iC AZ 8S034
MOMMX AZ 85034
(602)257-1656 CBM. 4990.
USE OF PERMIT d
GLE FAiOLY I.YW I.% G
SVD -),,OT 30 PI AN ZA.PF1tMIT LtTF, N(Yf n4CLUI)1P BL:)C;KWAI.,L:; C)P
POOL.. 75% PLAN CHfsCK F9& REDUCTION VOR MUL` IPLI? ISSANCE OF
SAME PLAN TYPE
CUSTOM C014STRUCTION 2,577.00 BF
FOR.CE's1P.ATIO " 01:f10 SF
GAP.A0FiQ,AIIP0FVf (811) 11,4[17.29
tai ni"7'• ) c, osr oxo consmU•C.pI`.dU.1V"
P1±.i.li+nr rm: sU1 .i.V.r ARY
C OMITRUCTION IEE 191.000.418.000 $J,042.00
PLAN CHECK FFE 101-000-439-318
MECI IANIC.AL FEE 101-000.421.000 S 11 L.30
ELECTRICAL FEE 101-000420-000 $139.34
PLUMBINO FU 101-000-419-000 $180.50
STRONCI MOTIt `14 Fft - RE SID 101 -000, -?AI -000 $21.49
ORAD1T O ISM 301 -0004U--000 $20.09
DEV 1,OPf' R IMPACT WEA"
ART IN PURUC= .PLACES - R_ HESIC 101.000 ,55--000 83"1.14
y i
`='A
"CiAir3C"l'109 AND P1,A1,F CHECK
$3,691.44
tia % 4e :33 PRE -PAD) . O
6(ji
* y fir+
V 6 41, 0'
393.44
I. J4 . ..
r
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
Set Backs
— / -
Forms & Footings
z- 6v
Slab Grade
Steel
Roof Deck
OX to Wrap
Framing
Insulation]
_
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath/ -
BLOCKWALL APPROVALS
Set Backs
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Lines
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I 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 Cq ` _ t, Encapsulation
Gas Piping
Gas Test
Final
Final
COMMENTS:
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice
POOLS - SPAS
FROM :
FAX NO. : 7605642238 May. 03 2001 08:51AM Pi
CITY OF LA.QUINTA
1 nime' A SAFETY DEPARTMENT
777-7012
INSPEqT
.1119N REQUEST LINE
777-7163
RJT HOMES LLC
Owner
Contractor or
PUT ENVESTTAENTS ENC
1-2 -
ul
il5orrw Number
POST ONJOBIN CONSPICUOUS PLACE
INSPECTOR AUST
AEELICASLE SPACES
17-190
pc -q
Rpel-Iful Ju r.LAIN LA PEIMI I
INCLUDE*BLOCKWALLS OR POOL
TYPE OF INSPECTION DATE INSP.
IATION- & SETBACK j6y—eo"r -eipil
FOOTING STEE
AKIN GROUND
PRE-GUNITE I- I I —
5-0 NOT POUR CONCRETE UNTIL ALLABOVE HAS BEEN SIGNED
CONCRETE SLAB,
JOISTS &GIRDERS
ELECTRICAL GROUND WORK
.4n"r POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUG T5iS & GAS TEST
HEATING &VENT- A/C
FIREPLACE
ROOF
BOND BEAM
Q.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR I
POOL PRE PLASTER
K
ABOVE APPROVALS ' 00 NOT INCLUQE RIGHT TO
.-.,^LIIMI„pec ^C)rum IDV RtIICDINig -
Certificate of Occupancy
City of LaQuinta
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 incompliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: ' 79-195 MANDARINA
Use Classification: SFD Bldg. Permit No.: 0008-201
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS ING Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034 `
By: KIRK KIRKLAND -
-L Date: 5-3-01
Building Official
POST IN A CONSPICUOUS PLACE
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