RPL (0010-169)79305 Mandarina
0010-169
_LICENSED CONTRACTOR DECLARATION\r" I h6lireby affirm under penalty of perjury that I am licensed under provisions of -1, --,66apter 9 (commencing with Section 7000) of Division 3 of the Business andC4 Professionals Code, and my License is in full forceancl effect.,. -
License# Exp. DateCD MLuB Iliac, Al711/01Ir Z 1-_, Da Signature Of Cr- OWNER -BUILDER DECLARATIONLL1, LLJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's0- License Law for the following reason;( ) el, as owner of the property; or my employees With wages as.their solecompensation, Will do the work, and the structure is not intended or offered forale, (Sec. 7044, Business & Pr1, as owner of the property, am exclusively contracting with licensedcontractors to construct the project (Sec., 7044, Bus in6ss A ProfessionalsLOXNJ Date Signature of OwnerWORKER'S COMPENSATION DECLARATION0 - fr I tiereby -affirm under penalty of perjury one 'Of the following declarations:F-m, 0 11 have and will maintain a certificate of consent -insure for workersX Uj — cor _ens` tion, as provided Jor by Section 3700 of the. Labor Code, for ' the.0 _J pdrf6rmance of the work for which this permit is issued.< *1,J—J"l have and 'Will maintain workers' compensation .insurance, as,required byL) Sdbtion 3700 of the Labor Code, for the performance of the Work for which thisCL: U-) permit is issued:-My.workers' compensation insurance carrier & policy no..are:Carrier olicy No.
~ `~
IMPORTANT . Application is (This section need not be completed if the permit valuatio. is f6r
. ( ) I certify that in the performance of.the Work for whic.h,this permit is issued,
I'shall not employ any person in any manner so as to, become subject to the
vorkers' compensation laws of C'alifi5mia,'and agree' -that if I should become
sOject to the workers' compens, tion provisi6ns,of Sebtion 3700 of the Labor
Applic
Wirinin§:.F.a"ilure to secure Wdkers' Co npensation coverage is unlawful And
shall subject an employer to criminal penalties and civil fi6es.Ulp,to $100,000, in
addition to the cost of compensation, damages as7 provided for in . Section 3706
of the Labor Code, interest and attorney's fees.
hereby made. to theDirector of Building'and.Safety
for a permit subject.m e conditions and restrictions set hn h
app '. . I ' ' . I . 1 J .
1.:Eavhperson upon whose behalf this application iomade aeach person at
whpueequemandhorwhnoobenefitwmrkiapedonnod.unde,nrpursuonrvo \
.
any permit ooued as o result of this appnvaxnn agrees oo.'ashall, indemnify '
'mhold harmless the City o,LaQuima. its officers, agomu'amdemployees'
o.Any permit issued 000result v,this application becomes null and void if.
work is not vomn!v?neu within ioo duva from date of issuance o/ such
permit.,o,cessation oYwork for 18Odays will subject permit to cancellation.
|oortify that | have read this application and state that the above information ia '
correct.] agree to comply wit ,all;-City, and State laws relating to the building
representatives of this City to enter upon'
Signature (OwnefAgen*1<0 0 Date/t/
PERMIT
VBUILDING
DATE VALUATION LOT -TAACT.
-A VAIDW.00
JOB SITE 7
OWNER
CONTRACTOR DESIGP NEER
LA Q AlTh CA 9225,q
PF0.16"
TBLO 4990
USE OF P ERMIT
TUN CHWX M, 101-000,439 ,316 376.05
CONSTILUCTION ",S 101-000-418-000
I 421i,000
MECHANKA'11 YK -- P0011 101-000— $24-00
D'AAM MEM
.10
TMALFE10WK PIKES VIVE HOW
OCT
41 Y
,RECEIPT
''BY
DATE FINALED
PECTOR
[DATE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
" INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final I
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
POOLS - SPAS
_
l�
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
-��-/ dv
Gas Test
Appliances
Final
�2—
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
FRIOO RJT-HOMES FAX NO. 7605646505 Oct. 17 2000 03:02PM P18
QtY of La Quinta
PA BOX 1504, 78-495 Calle TamplCO
//UPA f T LaQU1nta,CA92253.(619)777,70.12
0 0
Building Permit Appik'ati6n and Tracking Sheet
Owner's N&rnle:'RJT Horntsi LIC
77-7 -06 0 o6 Address: PO Box 81*0
RJT 1t)ve$(MgnrS, Inc. Telephone: (760) 564-6565
1425 E. Uftiytrsily Dr. Project Description: Eel U1--iX, '.I'
LP Phoiniz, AZ 85034
ClOrl3trUVion Type:
4iw(,A(, Occupancy:
-7 Of Cmacl Pttson: (760) 564-6555
$Slirnaled Value
M
'PERMIT FEES
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