RPL (0010-170)79295 Mandarina
0010-170
r .T 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 # Lia Class,--—, r E p. Date
Dateff Signature of Contractor > -• ' ""^"""
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).
( ) 1, 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:
( ) .1have'and will maintain a certificate of consent to self -insure for workers'
co , pensation, as provided for by Section 3700 of the Labor Code, for the
,s
f pe ormance 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.
STAYS AIND
(This section need not be completed if the permit valuation is for $100.00 or:less).
O 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' compensationj visions of Section 3700 of the. Labor
Code, I .shall jfo hwith comply with those provons.
s: r, e r 4+ ,, r_Li
Date:/'% ,.. ,,I*' - r ,F Applicanty _ .✓1,
kle I'll
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
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.
f• 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" tate that the above information is
Correct. I agree to comply with all City,rand.,State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property4o' inspection purposes.
Slgnature 11(r ► ,.- ,. ,_ Date
(Owner/AgenQ
• r
4N.
BUILDING PERMIT PERMTk
DATE ! VALUATION LOT (}(Ijp}p TRACT
JOB SITE 4
APN
ADDRESS
OWNER
CONTRACTOR /DESIGNER / EN JNEER
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LS5034-
PR()R= AZ 85034-
(602)2571656
(6n?)'257 1656 .. CBMf :4.990
USE OF PERMIT
PDOL AMAMI SPAT `
PRZ!rPL&S'l"U, INSPECTION, ;POOL E.fK!!i'j3°ME•,fi3T ENCLOSC,tRM dJ NO3
P60L AMOR SPA 45
rel, 10 -000-439-315 05
C'ON11:13'Sid tC'Y'Tfi3d Fey, 101-000-418-000 V $117.00
ECHiWt W,FRE -oP00L 101-000-421"000 $24,03
L111'IRICAi:. TX V- 001, 101 -OW -42,0-000 $45.00
P1.XFM010 "hilly POOL 1011-000-4.19-f. 00 0141
FAIJB-TOTALC014 `'. RUC 1014 AND
4
..
0TOTAL
VKRM IF= DUP. NOW
OCT 6 2000
ry
u
.JIT 0
RECEIPT
DATEj
BN^
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
Gas PipingE[
c t
` I!
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 Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
2
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)
9Jr—YCMES FAX NO. 7605646585 Oct. 17 2080 03/03PM P28
'
City 'of La Quinn
BuIldIng &, Safety Dlyb1on
P.O. Box 1504, 78-495 Calle Tampico
La QuInta, CA 92253 - (619) 777,7012
00 D
-logo— Building Permit ApPkatlon and Tracking Sheec
f5— Owner's Namc;'RJT Homes; LLC
CitY,ST, Zip: L2 WWII, CA 92453
—Inc.Telephone: (760) 564-6555
14?5 C. ufliyersi(y Dr. Project Description:
Photnix, AZ 85034
69064S City Lic. 0: 4990
COnstruction Type: Occupancy;
` M -E EHEEEF
Con;act Pcrson: Chad Meyer Sq. Ft.; R Stories: d Qnas
1 of Coniact Person: (760) 564-6555 Estimated Value
gr Project:
APP 7
- K. -IN mm
Mill
511 1
021
PERMIT FEES
T
a"I
O
A RE -INSPECTION FEE OF T 3 0
WILL BE CHARGED IF THE APPROVED o
PLANS AND 10B CARD ARE NOT ON 3
THE SITE FOR A SCHEDULED L
- IN ECTION.
o Z 000L
- j C)
co
0.
Of
CITY OF L • iIVT%ru COD
N BUILDING & SAFETY DEEP=T
- APPROVED
aQ FOR CONSTRUCTION 3
DATE _ -0-100 . SY_ .