SFD (0008-194)79265 Mandarina
0008-194
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
7
rr 690645 B I; is 06/30/2(
Date,y— w Signature of Contractor t
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 yy/`
1 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 1143, COMPANY OF T Policy No. 1&1DE170041900
(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 pr . ov1sions
Date: ' Applicant .t .i.X 'F T " l
Warning: Failure to secure Workers' Compensatio 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.
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) ~ l ,fit - ' Date f ✓ .
BUILDING PERMIT PERMIT/t
DA o_E///jyVALUATIONLOT. S'''94 TRACT
SG ? +C e' 17 2447.2
JOB SITE
ADDRESS AwDAP=A
APN
77. ww060.004
OWNER
CONTRACTOR/DESIGNER/EN &NEER
Il 1il i'lii, )13C.
Rai' Dwammm, b1c.
1425 F. UNWFRWI DR1'C E
142,5 , "UN_rV VXf DRIVE
pifol'm ' 05034
P1.1OF,A M ; AZ 85034
(602)257e1656 C.5'0 499Q
USE OF PERMIT
S.1AT01.11? FAMMY DWEI- O
SPO-LoOT 23 PLAN 2A-PI9RM1T DOES NOT INCLUDE SLOG WAL8,S OR
POOL
- 0flTtjM CONIS RUCTI )N b M100 SF
PORC10A'i 10 20.3.00 SF
"MOEICARPPORT (SP) l lj407.20
-
.\i0ST ilia ` 0N,7dZiMG.J.J0
214,SM5.40
q yyy,, yZySyt7>4.. a"1X
bff PER
CONSTRUCTION FEE 101.000.41 S-000 $1,042.00
PLAN CHECK FEE 101.000-439-318 $957.97
MECHANICAL FEE 101.000.421-000 $111.50
KLRCTR1CAL FEE 101-000-420-900 $159.1M
PLC) MB I]HO 118 10J-000-419-000 $189 50
STRON0MOTION FFE RE51D 10,1-000-231-000 $31.49
c'1t"1ri1.i: YNG PER 101.007-42.3-000 $20.00
DEV'EIDPDR UMPAC:T FEE
;'. ART 114 PIA)LIC PLACES - RESI% 701 U000-255-000 $37.14
7
SL tt L 'J1JN '1—IJcrri()N MD P1 -M C PICK
$4,116.84
'VOT
LESS PRE -PAW rK9,3
ftoo
mn 1tTITS UE _flow
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
1 `""'Aj
INSPECTION RECORD a�"
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 & 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
I 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
Sewer Connection
i�
�'"
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:
FROM :
.vW I lc1
FAX NO. 7605642238 May. 15 2001 12:33PM
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
OF 777-1012
INSPECTION REQUEST LINE
777-7153
RJT HOMES LLC
owner
RTI' INVESTMENTS INC
Contractor
U1308-194
Permit Number PNCE
posT ON J613 IN CONSPICUOUS
B
INSPECTOR LESPACES
jgdD
INCLUDE BLOC ALLS OR POOL
A
L
ABOVE APPROVALS 00 NOT INCLUDE RIGHT TO
TARN ON UTILITIES OR OCCUPY BUILDING
Pi
N
p
--TYPEOF INSPE-CnON
FOUNDATION &SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM'
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE L
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
6-"WOT POUR CONCRETE L
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING
INSULATION
COVER NO WORK I I
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POO FENCE & GATE
ii
W90 SEPTIC TANK
ELECTRICAL
PLUMBING
r' ?•1_ GAS TEST
,PING - AIC
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS 00 NOT INCLUDE RIGHT TO
TARN ON UTILITIES OR OCCUPY BUILDING
Pi
N
p
City of La' Quinta.
rw
w
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: 79-265 MANDARINA .
Use Classification: SFD Bldg. Permit No.: 0008-194
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 5-15-01
Building Official
I POST IN A CONSPICUOUS PLACE