RPL (0010-168)79315 Mandarina
0010-168
y 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-"' xp. Date `
Dyt ,K Signature of Contracfo r
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 Signature of Owner a
WORKER'S COMPENSATION DECLARATION F
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'
componsation, as provided for by Section 3700 of the Labor. Code, for the
4pnHo' rance of the work for which this permit is issued.
n ..rhave 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.
S'C.ATE i'L11 D
(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 CaliforniaA,and agree that if I should become
subject to the workers' compensation,,pvislonslof,Section 3700 of the Labor .
Code, I shalt f- tthwith comply
Date Applicant 4'''PJ
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 ,aiithorize,pepresentatives of this City to enter upon
the above-mentioned property ford/iinspection purposes. f
,s 3
:Sig ature (Owner/Agent), ! ; - - -:-•• Date . 0
BUILDING PERMIT PERMIT#
DATE e VALUATION LOT TRACT
Y p tt0
JOB SITE
ADDRESS
APN
-31.5 IUMDAR 11 A.
OWNER
CONTRACTOR/DESIGNER/EN (NEER
RR110-m s,.
P10. BOX 810
1425 X lWiMITYDRIVE
LA QTTiWfA CA 92233
PHta ly, 'AZ 8:5034
(602)237.1656 . CBL4 4990
USE OF PERMIT
Pt;C 1J.14A ONLY. BE IV, PLACE AT '
PRE-F'I ASUR M113rt3T(.TIOrK POOL EQU11448M MCL-03EiR Is'HOT
I` TCF,.U'[?ZJi) 3`N TiM 1311.9MIT.
Paul,. NDIO?1.apt.,
EMMAM C09f OF CO,12S'1!RVMOX
1'L:,0W100
:tr?1"?M FIN 61U No"'Ry
PLAN CHECK PSE 101-000-439-318 mos
=44=0=1014 R9 101-000-418-000
i`9.F.,C'kZANTCAL YEE-- POOL 101-000 -421-000 $35.110
it;I.?FCTRICAL 1199, -- POOL. 101 _000.420.000
PLUMP -Mo YE - P60L 30 i -000-419-'000 STY. 00
£1 T"k3=% iJ;`; ll.' • J71'Is
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OCT
RECEIPT
DATE 1 d,
BY ty A
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
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
POOLS - SPAS
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Pibg. Test
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
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:
RJT—HOMES FAX NO. : 7605646505 Oct. 17 2000 03:01PM P16
City of La Quinta
Building 81; Safecy Division
P,C), Box 1504, 78.495 Calle Tampico
LaQu1ntajcAq22S3,(61q)777.70-12
Building Permit Appiicatjorj and Tracking Sheep
A0,11c'sS —7—
vc5 Owner's Name;'
RJT Homes; LLC
0_
177 Address: PO Box 810
City,ST, Zip: LA Quints, CA 92 253
RJT Investments, Inc.
Telephone. (760) S64-6555
Telephone, (760) S64,6555
14 25 E University Dr.
Project 04scription:
2,9 Phoenix, AZ 95034
(60?) W-1650
690645
City Lic, Y: 4990
Z, -
S
Construction Type- 11fu,rOccupancy:
74t,
Project type (circle one X:N gdd'n Ahcr Rcpbir
C31);!C: Person:
Chad Meyer
Sq. Ft.:
q Stories:
0 ur,",
;or Contact Person:
(760) 564.6555
Ssiffnaled Va)uc of Project:
APnj,QA1M.
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