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SFD (0008-197)79235 Mandarina 0008-197 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 690643 B HIC A 06.13(112(. f• Date_ _Signature of Contractor ' al (i -",/, 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). () 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 kiy 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 IWO. COMPANY OFT Policy No. WD9170041900 (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.. Date: Applicant -'—p 6.411, ,y 12-1 Warning: Failure to secure Workers' Comp ensation`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. 'y 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)`r! s• t {• ✓ Date.• 5 - r <✓ _7 BUILDING PERMIT PERMIT# 114 DATEJ VALUATION E3 LOT TRACT / i! $214gv%5.4 . lG MS47*2 JOB SITE ADDRESS 79 2053 Il+iA".f MA APN 772-060-004 OWNER CONTRACTOR / DESIGNER / ENGINEER RiT 3N " ". mmm, rac R" M'VESTMimrs, 1425 X "tJUMM'1'3t' DR VE 142517 UNIV".EN.y1 W DRIVER PHOENIX .Z $5034 C CYMHX AZ 8$034 (602)M-1656 C I;Q,,, 4990 USE OF PERMIT WME SIM. I.,C?T 26 PLAN dA-PVkMIT OPE•S NOT INCLUDE, BLOCICSY'AL LS C7R POOL, 75% PLAN CHECK 2 DUCTION FOR, WRIANC1. OF IRAY1I, P .r1.,,6tci+l TYPJ CUSTOM CONSTi iiCTION 4977,00 Sly PORCH/PATIO20.1.00 SP, XARAGPJCSCPRT(SP) 161*040,M) C05T Off' 00NMU M1°dC2N 21 4ASSA0 ' PEVWr FM 9111bRWARY CONSTRUCTION IEE 101-000.418=(100 $1,1142,00: PLAN CHECK FEE 101-000-439-318 $214.4 77 MECI-IE'sNICAL FEE 1©1.000.421 "Q00 $111450 ' 91,r,C RLCAL FEE 101-000-420-000 $1139.34 PLUF► BINO "IF: 101-000-41.0-000 8180.50 STRONG MOTION ftE - IE,ESII7 101-000-24 1-000 0).49 MADIN03 .RE 101.000-423-000 `12tIA ]DEV 1,0PEII.IMPA.CT FEE $I,9ti7.i1U ART IN PUBLIC PLACES - .i E,9II .101-( 00.255.000 M14 i 7l -TOT4,CON'T UCyITOM M7f3 PLAU CHFICK $3,69.3.44 . LESS ;! M PATO FRUS $0,00 . v\ , .•w , 4 p p. g `3' FL9 D6 F Q Ary • a Lr-. 0u .S.Crd :G J^.i!.lMA S J: .:91F Y y d4. ,693.44 RECEIPT DATE BY DATE.FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs (j(} Underground Ducts Forms & Footings _`� �j -4 Ducts Slab Grade _'� ej- WI Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation L�` •-6d ArIc 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 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 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 _ r�- Pool Cover Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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) FROM : RJT-HOMES FAX NO. : 7605646505 Apr. ;CJTY OF LA QUINTA BUILDING & SAFETY DEPARTMENT 777-7012 INSPECTION REQUEST LINE 1777-7153 RJT HOMES LLC QwAar._ Contractor RJT INVESTMENTS INC Permit Number r POST ON JOB IN CONSPICUOUS PLACE INSPECTOR T. " dCQ LE SPACES INCLUDE BLOCKWALLS OR POOL TYPE OF INSPEGnON I DATE I INSP. '• • GROUND SYSTEM ,- :: DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED •:,.'CONCRETE SLAB cwu JOISTS & GIRDERS ELECTRICAL GROUND WORK ,aOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED • RC7WGbl•E ECTRIC ROUGH PLUMBING _ ROUGH GAS & GAS TEST —0 HEATING & VENT- A/C BOND BEAM Q.K. TO WRAP GROUT 0 4' 0 8' INSULATIOr PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR ( EXTERIOR LATH POOL PRE PLASTER POOL FENCE &GATE SEWER SEPTIC TANK i , i ELECTRICAL PLUMBING 1NG - A/C `HUUbt NUMULK, JOB COMPLETED TEMP POWER ASOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING 25 2001 10:17AM P1 ; I; i' L I! i; f' S: Y., P't Certificate of Occupancy City of La. Quinta 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: Use Classification: SFD Occupancy Group: R3 79-235 MANDARINA Bldg. Permit No.: 0008-197 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: 4-25-01 POST IN A CONSPICUOUS PLACE