SFD (0006-259)79335 Mandarina
0006-259
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
690.5 B WC A Ot+ (192i
Date(' 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). _
( ) 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 6-y- Section 3700 of the Labor Code, for the
performance 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:
Carver IN& COMPANY OFT Policy No. 1 DEM041400
(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, 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:L' ,'i 7 a-- Applicant
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 land 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.
f' .
Signature (Owner/Agent) Date ' '. •-'
BUILDING PERMIT PERMIT#
DATE _ VALUATION LOT 0-259
TRACT
U 7. c, $214, AO 16
2"47-2
JOB SITE
ADDRESS 79-3351.1 MWINA.
Rte
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RJ .L IN `%E:,.A b9ik:.M, IWC. 3
RJT W v Gq.7 f.L1o.G,LS iS, 1MC.
14251'.'UNIV r[=1°Y• DTUV.ly i
1425 R.
Pilo aum A.V, 85034
PHORMC
AZ
85034 '
(602)257.1656
C1 Ib0
490
USE OF PERMIT 1
A7C3• ,I: laAAr ..SP 7 1•! it Cr
SM. LOT 16PLAN 28 PERMIT DOES Nar INCLUDE BLOCK 'WALLS OR
:POOL 75 % PIAN CHECK PER REDUCTION FOR, ISSUANCE OF SAME
PLAN TYPE
CO3'TOM CONSTRUCTION 2,97 .00 SF
r< PORCH/PATIO. 203.00 Sr
F ;
t:•► j
0AFfAGWCARPORT Q%j 1107,26
't»
M : =D COSI' orl O®N1 UCT, (ON
144,M40
:C''EY#MT FIRE SUMAMICY
h
€
FRE 101,4000-418.000 V,D42.00
twwCONSTi1.LICTION
r, 7-
` "
PLAN CHECK FEE 101-000-434-318 $214.47
MECHANICAL FEF 101 -000 -421 -WO $111.50
ELE..CTI C.AL IEEE 101-000420-000 $169.34
PLUMBINO FFE 101.000-419-000 $180:40
STPOF3Ci.AhMION FE - RESID 101 -000-MI •-000 $21A9
GRADING FEE 101.000.423.000 $20.00
.DE'IrLOPFJZ IMPACT ME $1,407.00
ART IN PUBLIC PI,1}.C'!E,S - RESIC 701.000^2-55.000 $37,14
SM -TOTAL Ct31dS"tRUCTIO.N? AND P.1'.,AN {."1" E
$3,693,44
L&93 PRE•.PAW FI
$0.00
*f MAL PkIRAW i M ME NOW.
0,W3.44
RECEIPT
DATE
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
�j. 210_ GJ
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�f
Drywall - Int. Lath
00
Final
r d2 Gy—
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
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 Piaster
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:
FROM
FAX NO. 760564223e Jan. 2e 2002 09:22AM Pl
92
CITY OF LAQ'UINTA
. . . . . . . . . . .
ek BUIDING & SAFETY DEPARTMENT
NS.P'TrA777-7012 'ECTION REQUEST LINE
JUN 72000 777-7153
RJTI
Ow&rl , '—r-'MI'STMNTS, INC
-r=- --------------- -----
Contractor RTI' NVEiTMENTS INC
Permit Number 0006-259
POST ON JOB wi CONSPICUOUS PUCE
INSPECTOR MUST SIGN ALL APPLICABLE E SPACES
JOB ADDRESS 79-335 MLANDAP-INA
SFD- LOT 16 PLAN 213 PEMT DOES NOT
INCLUDE BLOCK WALLS OR POOL.
TYPE OF INSPECTION DATE INSP,
_Z I
FOUNDATION & SEMRA_CW-- r "P...ff -..r-Av I
I Ml L"
PR
%ufluumpRETEUNTIL AUA13OVENAS BEEN SI
CONCRETE $LAa
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
Cry NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SI
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST lip
HEATING & VENT -A/C
ROOF -1 -/igl CRY
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 S'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FENCE 6 GATE
SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
L GAS TE -57r
'ROUSE NUMBERS
JOB COMPLETED
TEMP POWER.
'V