SFD (0008-193)79275 Mandarina
0008-193
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 # t Lic. Class Exp. Date
690645 ,F3 HIC A n x'6130/2(
Date gf, a-60 Signature of Contractor v -_.v
v
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 Sianature 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 OSS COMPANY OF T Policy No. WDRIWO41,000
(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 th • e p ovisions.
Date: — -: (f-44 Applicant 11-
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 x`
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. j
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 applicator -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) t T+ 1 t - ti% Date.• -r%Q
v a
t
LUATION00#18-1.1;
DATE, V LOT TRACT
BUILDING PERMIT PERMIT#//
r ', 28447-2
.33-50
48 n
JOB SITE %
APN
ADDRESS '7 -,2P7 q A AMA
772 _
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RJT It+Ti 'I•'I"r:3, M.
R.T T IlMN'I MT11 s,114c,
147,51?. Ci VERT` C D pda
14.2.E 13, WfV1 NOTIT DIM
PROEM. 1>LZ 85034
PROEM AZ 85034
(602,)257-1656 031.0 4990
USE OF PERMIT
•
SKI- IAT 22 PI. Klq 3.A-P81WIT 13OM NOT INCLUDE hLOCKINA114 OR
POOL
Ci3OT01M COISTRUCTION 2.833.00 SF
FORC HIPAVO I30.00 Sid
"MGWc ARPORT (SF) 11,3a3,Pa
-LH'g1 D GCaST OF r,:Csii'7S"l1 ?UCJC.I0N'
233,'748-'50
IIEP 1`I' `1,,.D. py' -q SUMMARY
CONSTR.I1C TION i ;: 101-000-41 8-i000 $11103,so
PIAN CHECK FEE ` 101-000439-318 $906,01
MECHANICAL FEE 101.000-4-21-000 $103.00
XLFCTPJC;AL FEE 101-000-x20-000 $169.22
-PLt -MOINO FEE 101.000-419.000 $1SO.J0
STRt NO MOTION IrFY- - R SID 101-000.241-000 $23.37
ORADING FEB. x.01-000.423!-000 $200
DIEV'i 1.4pL+R IMPACT FEE `w; $1,907.00
.A.R.7' TIS PUBLIC PLACES - I1LE21f*1701.000.255-001 554.37
1 '
STU .-TfiTAD CON :` iON AND HLAN
$4,502.97
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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
Exhaust Fans
OX 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
-rte
Drywall - Int. Lath
Final
- g 0
Final �_ E 0 �
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electpe
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:
FAX N0. : 7605646505 Apr. 16 2001 12:45PM P3
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
ey OF • 777-1012
INSPECTION REQUEST LINE
777-7153
.i
RJT HOMES LLC
Owner RST VESTMENTS INC
Contractor _
''v?iliill i•tum'Y'llON JOB • INi
INSPECTOR'
INCLUDE BLOCKWALLS OR POOL
PATE IN3P.
TYPE OR INSPECTION mei
)ATION 8 SETBACK d ,
VG STEEL
MAINGROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
NOT POUR CONCRETE UNTIL ALL
KEE
ABOVE SIGNED
DO
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
y .SOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS a GAS TEST J
HEATING VEPiT AIC
TtREPLACE
60
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' p 8'
INSULATIDN "
PRE -ROOF
COVER NO WORK UN T L ABOVE HAS BEEN SIGN D
ALL INTERIOR
EXTERIOR LATH J
POOL PRE PLASTER
FENCE 8 GATE J
c F AEPTIC TANK -
FINALS
F , \L GAS TEST
JOB COIvIPLtTED I - ---- - -•"" ' --
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
^^VII IOV wi III rnNh
Ce
rtificate of.0ccupancy
City Quinta'.,
of La
Building and Safety Department
C
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
79-275 MANDARINA
Bldg. Permit No.: 0008-193
Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC
Tom.
Building Official
Address: 1425 E. UNIVERSITY DR
City: PHOENIX AZ 85034
By: 'KIRK KIRKLAND
Date: 4-16-01
POST IN A CONSPICUOUS PLACE
Elm