SFD (0008-192)79285 Mandarina
0008-192
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 forceand effect.
License # Lic. Class Exp. Date
690CAS }3:r., 06, `3C J2(
Date' ' j Signature of Contractor e- 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 isnot 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). -% . ' _
O 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
Policy No.
P.M. COMPANY 0117 " P%r t 1 i0Qt3t900
(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, Lshall forthwith comply with those provisions.
Date: j '1 1 /- r Applicant
x Warning: Failure to secure Workers' Compensation coverage is:,unlawful and
shall subject an employer to criminal penalties and civil fines up t0`$1 60,000, 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 5
for a permit subject to the conditions and restrictions set forth on his .a
application.
1. Eacl4lperson upon whose behalf this application is made & each personat
: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 isnot 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 prope~rtyy for inspection Lurpses1 Xti`l r G
Signature (Owner/Agent) --! Date 41
BUILDING PERMIT PERMIT#
DAT '• VALUATION LOT OiTWIY-) TRACT
+.hra't;.-iz
fp
8447A 7
CiiJ 9 .huQV b'A2
JOB SITE
ADDRESS 79- ' MANDARMA. 4
APN
+ 772••060-004
OWNER '' I
CONTRACTOR / DESIGNER / EN (NEER -
:P..T'x it 'e livPt''a;121E;..T`rtl
AJiti1Y' ',iVT",
142.3 R 'E NIVI : .MI DRIVE
1425 X DIUvJi"RMX 3.3RIVE
PHOMgm ` .AZ 85434
PROF -Ni`/ AZ OS034,
.
(602)R57 16.5.6 -CM1:ef 4990
.
USE OF PERMIT -
a
9101,17 FAWt Y DWff(.L1. G
NI i• LOT 21;PLAN. JA e.PERMIT DOUS 140T INICLUDE 111,0 -CI< WALLS OR ~'
POOL
CUOTOM C0NSTRUC T IO14 x,4'0,00. SF
POPICHIPATIO 1I .Q0 Dir.
0A1tA(JFJC,'P RPOWf (,8%9 x x,tr69,d0
17MA1 •A C09f OF CCJ, TS',t',4' • TC110.
2,06,f 772-20
•(• Y . gyp'+[' j+y p• /7•., , • .'I9y
COMOTRUCTiON M 301-tIW 418_000 $1,014,04
PLAN CHECK FEE 101-000-4391 -318 $251.50
M9CH-tWCAL Fff. 101.000-421.000 $105,00
1.rI,,ECTRICAL FM 161-000-420-000 $1,36,4'7
PL IMD1NCS FZE 1411.000.419.000 MUD
5'I R0240 MOTION FEE - RESID 101-040-2.41-000 $20.62
0M. DJN0 FEE 101r00 $20.00
DEVEWP-EP IMPA6T FES i., f $1;907.01)
ART 11+1 PUBLIC PLACES • R911f -01.000-•23 54000. $15,93
1 ts>
i 9[0J1 •-YOT Ct R & 9E L5 "i f)11 4 3 FL,64Aa Cj 1 C"1e
$9.,'254.32
F LESS PRE-:PAAI[3 FM
F•4 ^ .
ka'
., $0.00:.
'14"
RECEIPT
DATE. !
^ Y
-
DATE FINALED
INSPECTOR
•
f
'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I 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
Firepiace 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 7 c o
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
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)
FAX NO
7605642238
o'
CITY OF LA OUINTA
- BUILDING & SAFETY DEPARTMENT
C:.
OP 777.7012
INSPECTION REQUEST LINE
777.7153
Owner RJT HOMES LLC
Contractor RJT INVESTMENTS INC
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR- LE SPACES
JSFD=IAV
INCLUDE BLOCKWALLS O1 VOP L
TYPE OF INSPECTION DATE I INSP.
FOUNDATION & SETBACK - -kJ
Aug. 15 2001 08:47AM P3
FOOTING STEEL l
MAIN IGROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
D. -MOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
HEATING & VENT- A1C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP -
GROUT 0 4' C S'
FRAMING 0 7
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED:---
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
ELECTRICAL
GAS TEST IK- PS - O
k:_4_j'ING - AIC
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
Ti jam mw I mi rncC nM of f:UPV Rint nlNn
I
I
Certificate of Occupancy
Cityof La. Quinta.
V•
5
Buildingand SDepartment
This Certificate issued pursuant to the requirements of Section 109 of the •Uniform Building Code,
certifying that, at the time of issuance, this strucsture was in compliance with the various ordinances
of the City regulating bui/ding construction or use. For the following:
BUILDING ADDRESS: 79-285 MANDARINA
Use Classification: SFD w Bldg. Permit No.: 0008-192
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: 8-15-01
Building Official
POST IN A CONSPICUOUS PLACE
ME ■