RPL (0010-166)79335 Mandarina
0010-166
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
,,:Chafiter 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 -Ezp. Date
r
D tAe' r.- */Signature of Contractor `'
r• r if'
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
pe°Q'' ance of the work for which this permit is issued.
( _)` 4,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:
Cartier Policy No.
11 J
STUE
(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 ,a/nd agm that if I should become
subject to the workers' compensation ,prrovisions of,6ection 3700 of the Labor
Code, 1,shall,f orthwith comply with,th? provisions./
Dater/ 1 • Applicant ,> J .. • -. °~
Warning: `Failure"to'secure Workers' Comp e sation 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 r
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.allaCity, and State laws relating to the building
construction, and hereby authorize" representatives of this City to enter upon
the above-mentioned property for nspectionrp`urposes.
Signature (Owner/Agent) •j° ' ,f 3 Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 001O. -J.66 TRACT
APN
ADDRESS
V-01:35 MWI'Yy.AtUS '.
-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
WT HOMU3, UX
L 1' IN-VuTrur. wrs, nic.
P10 -Boy; 810
1491
LA.QUIiJTA CAN 92253
:RHOP14rX AZ 55034
(602)257 m 16015 SD CDU 4990
USE OF PERMIT
POC?9:,"YYrYR SPAI
1°'Ria P1,A'ttT12,J YN&PY?sv'l ION, 01'OOL HQLTIPM T [,Adt:e'<(;,t SURK 10NOT
l y4 A t t ys A
C' % .+di. 'SND OR a a A itiYVi+r VM E+cl
zM"'> ED COgr4DF 4 ONFrRtxMION,
10w).,00
PLAN (111111XIK FRE 10)-000-439-318 176,05
CON.SMUCTION F29 101-Ofle`n'-418-000, $117.00
AWHAXIVAL FEE .. KOL "01-000-4-21-000 SUM
Le i Ir..CTPUC.A.L PEZ - POOL. '1012 000,420-000 lS.StO
5 3,E3I i, 2AiC,v - vle 101-)!)0.419400
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' T., y- 'L, .,l.•°t .k ' 'LT ' `.$t Y+ .A 13I3 °L. i G'rt .l:, T. ":
, a27 +".0
I -92V PRE -PAM IWO
$0,00
OCT 2 6 20gJ TOTAL F MlAff:@]1 S DUE NOW
'ITY OF LA QU19T
RECEIPT
DATE k
BY
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
-Z
_
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
. Gas Piping
PLUMBING APPROVALS
TeTe
Test
Gas GasElecFinal
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
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)
Final
COMMENTS:
RJT—HOMES
FAX NO. : 7685646505 Oct. 17 2000 02:58PM P12
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City of La Quinta
-le
P-0, Box 1504, 78-495 Cal Tampico
La Quinta, CA 92253 - (619) 777-7912
FECS
Building Permit Application and Tracking Sheet
List
'
ornes; LLC
.
CilY.ST, Zip: La WAU, CA
'
RJT Investrilents, Inc.INTelephone:
(760) 564-6555E.
'
Dr.Project
Description:
Z:P PhOtnix, AZ 85034
Dc t. Approval
690645
City Lic, 0: 4990
.StoriesC ntac!
Person- Chad Meyer
Sq, Ft,;
# Stories,
nm
-7 OfCOnlacl Person: (760) 564,6555
$Stinnaled Value or?rojccl:fillAPPLUIE
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Req'd
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FECS
PA "Ail
List
CS
Approval
Dc t. Approval
PERMIT PEE$
!Plan:Chcc Deposit
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I CITY OF LA (UiN TA
BUILDING & SAFETY DERT.
APPROVE
FOR CONISTRUCTION " I
f?ATF I a 2 o CSD BY
•tai.
i
A RE -INSPECTION FEE OF $30
•j .Y WILL BE CHARGED IF THE APPROVED
• PLANS AND 106 CARD ARE NOT @rN
• • - THE
SITE FOR A SCHEDULED
INSPECTION.
NO EXCEPTIONS! -
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