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SFD (0008-199)79215 Mandarina 0008-199 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 i 690645 h WC A, f- , 06%30/2f Date- s Ff — Signature of Contractor="4'/r OWNER -BUILDER DECLARATIOW 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). I () 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. ( ) 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 ft19, COMPANY OFT Policy No. C+ D1317tf041900 (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 withthose. provisions. Date: Applicant` o Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. :Rf• IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set' forth on. "his application. x :.' 1. Each person upon. whose behalf this application is made &`each person at " * whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. p / Signature (Owner/Agent) Date/*/^ BUILDING PERMIT PERMIT# DATE• '" LOT 0008.4w - VALUATION TRACT 214 A 20 2M47.2 BW6 slTE 77 APN ADDRESS 70415.MAKDAR.iNIA 772-01aii S10 OWNER CONTRACTOR / DESIGNER / EN (NEER RUT NVVEmumd't , :t c. Rn DJVFZ1MQ4-M, ]STC. 1.4251- U>rt VnE WY DA E 1425 L UIN2VER grYDKWE +k1C)r JI°iC AZ 85034 Plkmwx AZ 0034 I (60T)2"-1656 CSI¢$ 4990 USE OF MIT P7Et Rvuyy +7 r AMIL .y i t SI -D -LOT 23 PIAN 28 - PERMIT 1, DES NOT fNC LURE OLOCK'W:AL,L, OR POOL, 73% PLAN C:HF_•WK ITE iZ.l7.ClttE:TfOW FO.k ISSUANCE OF SAAJMK PfAN T i!P CUSTOM CONS TRUCTIOIl 21577.00 3F PORCH/PAT16' 203.00 SF GAPLAUIE/C,ARPORT (SF) I I t1 0,Z0 XS1M11WrKD COST OF cAmmi7ct-10N. 2X4,8WA0 :4'kmlYR r Fps 8101/WARY CONSTRUCTION FRE, 101.000.413.000 $1,042,00 PLAN CHECK FEE $214.47 MECHANICAL Fid=: 101-000-421.000 SI I1.S0 @.LECTRICAL FEE 101-000-420-000 $153.54 RLIJIMBING FEE 1014000.410.000 $1180.50 STRONO MOTION FEE RE -SID 101-000-2427000 $21.49 fOR .DING FFF i 01=000425_000 $20.00 DEV 9LOPER 11M PACT FEE $#,907.©E► ART IN. PUBLIC PLACES ItIWAI-000.255,,000 .D L -M ,AL C:b_14ffD U(°P10_W AND PIM M=K $3,60.44 y~ 'LMS PRE-PAIDFERS $0.00 jgv , ^ y rpm + UE 7 l ! S Sa.bS.CYl.S L ,T is .x/ 4Jd:. d9 Yf 3 693 4 $369341, 'W P9J.✓ :4"P i RECEIPT DATE BY/ , DATE FINALED INSPECTOR 1! r 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 - CQ 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 Sewer Connection p� _ Pool Cover 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: 05/16/2001 23:53 ' t 7605643341 LA OUINTA FAIRWAYS s CITY OF LA OUINTA a --BUILDING S SAFETY DEPARTMENT °f 777-7012 INSPE=CTION REQUEST LINE ' 777-7163 RJT HOMES LLC Owner INVESTMENTS INC ContractorRJT Permit Number POST ON JOB IN CONSPICUOUS PLACE ST IG L A PLIC E3LE SPACES QINggSS PppECTOR 3FU 7. INCLUDE BLOCKWALLS OR POOL TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK - FOOTING STEEL C MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED " CO CR ETEi SLAB -' ' _ J018TS & GIRDERS ELECTRICAL GROUND WORK G_ NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS d GAS TEST / v HEATING 6 VENT- A/C FIREPLACE ROOF BOND BEAM O.K. TO WRAP GROUT ❑ 4' 0 8' FRAMING INSULATION PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR vvTr SAA t AT11 A. POOL PRE PLASTER POOL FENCE 8 GATE SEWESk.SEPTIC.TANK ELECTRICAL PLUMBING r 'L GAS Tess nNG • NC HOUSE NUMBS JOB COMPLETE TEMP POWER ABOVE APPROVALS 00 NOT INCLUDE RIGHT TO ` .TURN ON UTILITIES OR OCCUPY BUILDING PAGE 01 P Certificate* of OMWL4 .- tY a. City of La Quinta -CFS tiQ Building and Safety Department of This Certificate issued 'pursuant to the requirements of Section 109 of the Uniform Bui/ding 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: 79-215 MANDARINA Use Classification: SFD Bldg. Permit No.: 0008-199 Occupancy Group: R3 Type of Construction: VN _ Land Use Zone: RL Owner of Building: RJT INVESTMENTS INC Building Official Address: 1425 E. UNIVERSITY DR City: PHOENIX AZ 85034 By: KIRK KIRKLAND Date: - 5-17-01 POST IN A CONSPICUOUS PLACE