SFD (0008-196)79245 Mandarina
0008-196
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
.690645 I3 WCI A. Jl :
Date ,ff,/-6tr Signature of Contractor 1 % ' 1 --
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).
( ) 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 lie
I hereby affirmfunder 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 OF `1' Policy No. WDE110041900 -
(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.
,! r
Date: ;,-.;- Applicant,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his va
application. t
1. Each person upon whose behalf this application is made & each person at '
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, &' shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of ;issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes,.
Signature (Owner/Agent)--x'{<"'•f. Daterr
BUILDING PERMIT PERMIT# -
"'
DAT y t VALUATION LOT 0008-1.96 TRACT
92`i4, A0 25 2844;-2
JOB SITE
ADDRESS 7,9_245 wgnRf,&
APN
772-060-004
OWNER
CONTRACTOR / DESIGNER / EN (NEER
sr Wil ,1WC..
X r MV I;1N-0, INC,
1425 X [)MVMk1._Y DRIVE,
1.42 5 7 .IV1:- 311T DT' cJ' 'k:
P1+I:004IX Z 85034
PH09M AZ 8504
(602)257-1656 GI"Kx41 4990
USE OF PERMIT T
Mal- FAhOLY r 4jiua
SFD- LOT 25 PIAN ZtpPk;RMIT DOLS NOT INCLUDE:BIX)CICTUVALL.S OR
P00L. W% PI CHECK VE F, RED .FOR 109UANCFd OF SAM I, PFA14
'T'YPE FOR ISSUANCE 01' SAME PLAN TYPE
CUSTOM CONS7'Rt1CT10td 2,MA SI;
PoizckilPtcTIO , :tE33.Otj SI:
0A.RAOFJCARPORT (SY) 11,40 ,ZO
D COST (Jif' ('0,iVa "1aVDC'f. 0H
214,$.40
• y q gsy+y+ y yy , E 5*%9-A. ;
d IMW .l1 EE I .LY ./ SR
.
COIIS'TRUC'.TIO14 FRE 101.000-416-000 $1,042,00
PLAN CHECK PEZ 101-000439-318 $214.47
MECHANICAL FEE 101.000-421.000 $111,50
F:I..ECTWCA1, LISA; 9 01 -OW -420.0010
PLUMOI]HO FEE IU1.00t -419.000 $180.50
S9 RONICt MOTION FRE - RESID 101-000.241-000 $2I.49
GRADING 101.000-423,000 $20.00
DEVELOPER IMPACT FM ro _'S i <x SI,967.00
ART IN PUBLIC PLAC39 - kiESK 7,01.000-255.000 SAM
t!
w 31IS 0TATr COI$cs".f I.TC AO1d AND PLM [_-MtryK
V,6! 4.44
0,69144
i .
.j-
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Tii�>p
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
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:
=j1 -;ONES
FAX N0. : 7605646505 Apr. 16 2001 12:46PM P4
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
{777-7012-
X INSPECTION REQUEST LINE
77 7-715')
Owner PjT ]TOMES LLC
` RJT INVESTMENTS INC
Contractor
0008-196
i Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL.APPLICABLE SPACES
A Am
J g
Sr`ll(a`I' Z
INCLUDE BLOCKWALLS OR POOL
TYPE Of INSPECTION DATE INSP.
FOUNDATION & SETBACK
1 i
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING 620
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB --
JOISTS & GIRDERS
ELEGTRIGAt_ C; RC1UN>✓ YNORK
L1oti 1QT POUR CONCRETE
UNTIL ALL. ASOyeE ..
HA5 eEEri~Sf. ; :D
E HAS BEEN SIGNED
- ..0 r
FINALS
.L GAS TEST
nNG - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWlrR -
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
3 TURN ON UTILITt Q nrt Mnc iev e .ni.n
A,
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT • A/C
FIREPLACE
j
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING,
7
INSULATION
PRE -ROOF
COVER NO WORK UNTIL
DRYWALL INTERIOR
EXTERIOR LATH
POOL, PRE PLASTER
POOL ENCE & GATE
S SEPTIC TANK
E HAS BEEN SIGNED
- ..0 r
FINALS
.L GAS TEST
nNG - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWlrR -
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
3 TURN ON UTILITt Q nrt Mnc iev e .ni.n
A,
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
ollowing.
BUILDING ADDRESS:
Use Classification: SFD -
Occupancy Group: R3
79-245 MANDARINA
Bldg. Permit No.: 0008-196
Type of Construction: VN 'Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC
-7--04,x /4veU7
Building Official
Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 4-13-01
J
POST IN A CONSPICUOUS PLACE