0008-200 (SFD)79205 Mandarina
0008-200
l,LICENSED CONTRACTOR DECLARATION
I hereby affirm Ondet penalty of perjury that I am licensed under provisions of,
'Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
rofessionals Code, and my License is in full force and'effect.
License # Lic. Class Exp. Date ,f
MOW BI HIC e/'a
Date -y- -4!,–,e,•,, 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 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 & Professionals
Code). fF
() I am exempt under Section B&P.C. for this reason
Date - ` Signature of Owner.;
WORKER'S COMPENSATION DECLARATION
I hereby affirmunder 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.
. ( ) 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, CoMp.AT4Y' OF g. Policy No. ' SMLyE170041$09
(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. gvisionsF,
Date: tf IM - e947 Applicant . !
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees:
IMPORTANT Application is hereby made to the Director of Bullding'and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each;•person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and -void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I -certify that I have read this application and state that the above information is
correct..1 agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertyrfor inspection purposes.
i
Signature (Owner/Agent) d- fs f `^ Date S— .
BUILDING PERMIT PERMIT# .
DATE VALUATION LOT"2 TRACT
tY ' -'$„.1,748 0 • 29 %8447-%
JOB SYTE
ADDRESS 79-2mYvux x'1mm
APN
- % P -W.-004
OWNER 1
CONTRACTOR / DESIGNER/ EN (NEER
3.1`1' IbNV7F 'MOM, ]N'C.
1NiTE:fI'iv>> rs, lac.
1425 Ir YTML-R Y17Y DR1V
PROEM AZ 85034
PIHOINIC3;, A SS(1 ff
(602)257.1.656 CBL* 4990
USE OF PERMIT
+
9 NOLL? VAMMY IYwW-L.3 G '.
SFD-LUT 29 PLAN 3E,POAM) I OES NOT INC, OVE RLOCIMAIA.'S CFS
POOL. 75% K AN CHECK F9.914 ROUCTION .FOR 188UA?NC E OF SAMA° PLAN
TYPE ._
CUSTOM CONSTRUCTION 1833.00 Sl?
PoRcl3fPA'P1C).: 130.80 SF
GAMOWC,ARPORT (SIO ., -11,329-80.
X&MMKI" , COST 01? CONURUC11,01*4
. v
3:''IsVAGTFRE SUfAMURY
C014STRUCTION FES 101.-000.418.000 31,100,50
PLAN CHECK b:E.E 101-000-439-318 $226.50
MECHANICAL FEE 101 00OA21.000 $103.00
EI ECT1•'.ICAL Me. 101 -000 -420 -WO $168:22
PLUIv1B3'P 0 FEE 101.000-4'19.-OGO 3188,50
STRONG MO`T'ION FEE - RE ID 101-000,441-000, $23.37
CRADINO FER 3,01-000=4 3.000 $20.00
Y; •
F7L "JL LOPER )MPACT ME's; . XI ., y1,9Q1:f2D
.ART IN PUI LIC P.LA,CI -1.000.255.000 $M.37
,RTIC
4l
'A T-T&.A>iiL C6MMITM- ON• AM ??1,0, YJ' C 14E0K.
x$3,823:46
mw. PRF.-PATr,.
rgmmn: now DMI
431,A23A6
RECEIPT.
DATEBY
%r
DATE FINALED
INSPECTOR
INSPECTION RECORD
w
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
l Cj
Ducts
Slab Grade
A 0_1
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
2- _
Drywall - Int. Lath
Final
Final
/
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final 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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
C
Utility Notice (Gas)
bally/G
L
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)
cOM ,P.JT_HOMES FAX NO. 7605646505 Apr. 16 2001 12:45PM P2
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
77,7-7012
INSPECTION REQUEST LINE
777-7153
Owner
RJT HOMES LLC
RJT TNV'LSTMENTS INC
Contractor
0008-200
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
sd _... ..
U 47A
INCLUDE BLOC]KWALLS OR POOL
TYPE OF INSPECTION oATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING SO
PRE-GUNITE 00D
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
• CONCRETE SLAB
JOISTS & GIRDERS
' ELECTRICAL GROUND WORK
s`
6 -AOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
GROUT 3 a' a'
ROUGH ELECTRIC
- - --_...-----------
FRAMING
ROUGH PLUMBING
ROUGH GAS & GAS TE
INSULATION-
HEATING & VENT -A/C
`
FIREPLACE
PRE -ROOF
ROOF
GROUT 3 a' a'
I
PFENCE & GATE
QO
3 R SEPTIC TANK
FINALS
} ELECTRICAL
S •
:>. PLUMBING
!' GAS TEST
:j 1fING-A/C
HOUSE NUMBERS
JOB COMPLMD
TEMP POWER
t
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- - --_...-----------
FRAMING
4 • . c
INSULATION-
^'
PRE -ROOF
COVER0 WORK UNTIL AB
VE HAS BEEN SIGNED
DRYWALL INTERIOR
07
s
:•: •
EXTERIOR LATH
-
POOL PRE PLASTER
I
PFENCE & GATE
QO
3 R SEPTIC TANK
FINALS
} ELECTRICAL
S •
:>. PLUMBING
!' GAS TEST
:j 1fING-A/C
HOUSE NUMBERS
JOB COMPLMD
TEMP POWER
t
`.HO(IN•..)t, Ulli Oh IS tic.. —r :
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ly
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Certificate of Occupancy
City of La Quinta
5
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: 79-205 MANDARINA
Use Classification: SFD Bldg. Permit No.: 0008-200
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:. 4-16-01
POST IN A CONSPICUOUS PLACE