SFD (0006-263)79295 Mandarina
0006-263
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 B 1_11C A a rt ae
w
Dat eF y 'j 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:
(' )' 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
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.
( ) 1 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 roa. C'C3mPANy OIC T Policy No. 1% r"I7E1790h19100
(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
''worker's'° 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. ,•
Date: f ✓ 7 4) Applicant >. Ql P r,.,l
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. ,
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.
. L..d
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT -X2.6.1'
TRACT
$214 f*SAO 20
JOB SITE
ADDRESS 79-2" AlADW.A.RTNA
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
Rxfwvwilaws, n4c.
R I' ll M -M Ui,1NC.
142511, LINIMISITY DIUW
142.) E, VINArM01TY DPJ'
PHOLVM AZ 85034
1>110EN C
AZ
85034.
(602)257=1656
CDL# 4990
USE OF PERMIT
&NOT.2, VAWLY DVML UNG
S.M T 20 PLAN 213 P1d'.L IT ODES NUP 1'tdCLUIV, BLOCK 'WALJ OR
POOL. 7A % PL,&N CHECK FPI; REDUCTION FOR ISSUANCE OF SAME
4 PLAN TYPE ,
CUSTOM CONSTRUCTION 2,577.00 OF
FORCI-11PAT16 203.00 SP
c3A,11. GFJC;ARPOWF Off) 111407.20
ESIMA17D COST 017 C0149fRUCTION2'IAAW40
CONSTRUCTION 1,72 101 x;000.4186000 $1,042,00
a
t
PLAN CHECK FEE 101-000-.439-318 $%14,4";
_• .w,,
MECHANIC'•AL, FEE 101.000.421-000 5111,50
ELECTRICAL FEE 101-000-420-000 $159.34
PLWI11NO THEE 101.000.419.000 $130.50
STRONG MOTION FEE - RESID 101-000-241-000 $21.49
Irl
G ADINO P94 1491.00042.1-4900 120.00
DEVELOPER IMPACT P29 $1,907.00
ART IN P1JWC. .PIACFS3 RZSIE 701.000.255-000( $37.14
SUB -TOTAL COXOTRU'C1147N AW) PLAN ,.i-.11 ' 5',
IF,..W -PAW FEES
S0100
WfAs.1Pl-.:aMT Mi ' , 8 DUE NOW
&3,693:44
RECEIPT
DATE
BY
DATE FINALED,
INSPECTOR
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 6–
Underground Ducts
Forms & Footings (*�)
Ducts
Slab Grade _ QQ
Return Air
Steel
Combustion Air
Roof Deck 7zW
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing– l-4
Compressor
Insulation - Gel
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
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:
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
Y 777-7012
INiikTION REQUEST LINE
777-7153
Ow INVESTMENTS, INC
ner
Contractor RJTY' CNVIESTMENTS, INC
Permit Number 0006-263 -
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-295 N ANDARINA
SFD- LOT 20 PLAN 2B' PERMIT DOES NOT'
INCLUDE BLOCK WALLS OR POOL:.'- •.•
TYPE OF INSPECTION DATE INSP
FOUNDATION & SETBACK 'L l: -I
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL AL ABOVE HAS BEEN NED
CONCRETE SLAB}
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L_ NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC .
ROUGH PLUMBING
ROUGH GAS & GAS TEST . p
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION y
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
L POOL FENCE & GATE
R SEPTIC TANK tJRK
FINALS
PLUMBING
GAS TEST
TING - A/C '
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY 81,114pING
Td Wd00:EO TOW 9Z -6nd- S0S9b9S09Z : '0N Xtid
9
S3WOH-1fd WOdJ
Certificate of Occupancy
City,of La Quinta
Building and Safety Department. m F
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
79-295 MANDARINA
Bldg., Permit No.: 0006-263
Type of Construction: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC
Building Official
Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 8-16-01
POST IN A CONSPICUOUS PLACE