SFD (0008-198)79225 Mandarina
0008-198
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
9064.5 DMC A" . A : 01WO/V
Date f f l(s ., Signature of Contractor —, _ L' j `' j
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 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 INS, COMPANY CI T Policy No. WDE170041900
(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 provisions. ,res
Date:"7 ¢"" Applicant, it {;!t
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 Bulldmg'and Safety .
for a permit subject to the conditions and restrictions set forth on his 77,
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 oflthis 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✓ ' i'
V
t
BUILDING PERMIT PERMIT" -
DATE -••meq /'/ LOT. - ' TRACT
,VALUATION
rV7 i( ti+ :3,707 28447=2
1
JOB SITE
ADDRESS w-22sm"i m r
APN
% Ie " .!6o- .
OWNER
CONTRACTOR /DESIGNER /ENGINEER
RJT INVWIVDT-3, INC.
D C 7p4Tm, 31yc. .
SITY:I It1VE
7 F /5 :'F ?.; UNIVE09- 1"Y I3iJVE
y1 4 g2/57 V1, ' i JNIVE
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PP.C7.Vl.'s6V.L/1. AZ 85034
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PRODIM AZ 9504
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(602)257-1656 CT4VI 4990
USE OF PERMIT ?
MME TAMELY DWEL" U G
SfMvL of 27 PLAN 3A -PERMIT DONS NOT INCLUDE BLOCitiWALI.,S OR
POOL 75`A PLM CHECt FEE REDUCTION FOR ISSUANCE OF SAME.PLW
TYPE ;
t"WTOM COW -T2 UCTIO14 21833100 OF
POR.CI-11PATI[d 130.00 SP
GA.R.AMUCARPOf T (SF) 113I8. Q
^x
Zf MdA7 D 0091° OF G`OMUR"!7•(:"£ EOR
233,749M
CONSTRUCTION PEE 101-000-418-000 $1,108,50
PLAN CHECK FRE 101-000-439-118 $816.50
M!;',CHANICAI, ir" 102.000-421.000 $1115100
EL1 CTR1CAi. FEE .101-00,0-4,20-000 $1600.22
LUMT 010 FEE- 101.000.411^000 9180.50
STRONQ MOTION FEE r RE.SJ 101-M-241-100 $23.5'
(W.01NO FU ` 101-000423-000 $10,00
DEVELOPER IMPACT FE?% ,
ART IN FU G PLKC}+3; ARgS1t-101.010-2.55.OW $94,4/
r C
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ISVP r ,t. El vstl U Crk l . t- ` . I" C -IT -1 ` ,
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U.113 M411AW FE
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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
—Q'j
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_ Cc!
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 Pibg. 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
01
Pool Cover
Sewer Connection
_
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:
F RUM : RJ 1 _HUMES
k-
F- HX NU. : rbb5b4b5175
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CITY OF LA QUINTA
f BUILDING & SAFETY DEPARTMENT
777-7012
INSPI=CTION REQUEST LINE
777-7153
RJT HOMES LLC
Owner
Contractor RJT INVESTMENTS INC
Permit Number
..P..O.ST• .ON JOB IN CONSPICUOUS PLACE
INSPECTOR r T § ff2.N 64L=61CABLE SPACES
114 ju^xwWk
JSifU 1.iji MAIN rhruvll I DOES IN M'
INCLUDE BLOCKWALLS OR POOL
Sep. b5 2001 W13:55HM F'1
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS B Eli SIGNED
CONCRETE SLAB -0, e;d -
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
bl.,-' JOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HrATING & Vupft I, ••
FIREPLACE
ROOF
BOND BEAM
OX, TO WRAP 4/ —
GROUT ❑ a' ❑ S'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
ELECTRICAL
PLUMBING
r L GAS TEST
r ,TING • A/C
HOUSE NUMBER;
JOB COMPLETED
TEMP POWER
FINALS
I/
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
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