RPL (0010-165)79345 Mandarina
0010-165
LICENSED CONTRACTOR DECLARATION
rl.hereby affirm under penalty of perjury that I am licensed under provisions of
r hapter 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 1 ExpR Date
ate 5{ "Signa4ure of Contracto, d -
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'
com"pensation, as provided for by Section 3700 of the Labor Code, for the
erformance of the work for which this permit is issued.
`_) have and will maintain workers' compensation insurance, as required by
(N6on 3700 of the Labor Code, for the performance of the work for which this
peimit is issued. My'workers' compensation insurance carrier & policy no. are:
Carrier Policy No. '
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of thework for which this permit is issued,
I shall not employ any person in any `manner*so as:,tofbecome subject to the
workers' compensation laws of California and agree that if ,I should become
subject to the workers' compen'satiopopr"ovision oAection 3700 of the Labor
Code, ),shall forthwlth;comply wltoAhose provisions..
Annfilnanta ns.. ea
r `"a
Warning: Failure to secure Workers' Coniipensation coverage is unlawful and
shall subject ani 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 cancellatio6.
I certify that I have read this'applica
correct. I agree to comply,with all
construction, and hereby authorize
tke Above-mentioned,oroperty for in+
Signature (Ownerl gent) .
Ate that the above information is
tate laws relating to the building
atives of this City to enter upon
urposes.;'
r9/
Date e
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE:
APN
ADDRESS
79 -NS MAMARYINA
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RX r 140NMs,
x'',0113OX 810 , ',
1425 V UNIVIs',R`MY DRIVE
LA QUINTA CA 52253
PHO17NWI ' AZ SS 3
MIX 41990
USE OF PERMIT
POOL ANDADR SPA
P?I OLMYRA 03L.Y. IM AT
p6t(,.,.A.Aq,. a 3y1hw4w"/A 44%RyE u1 r,Sp,' s"g11ALQ,Z ,.y723L g .P t<t ;E
q y a q
PR&PIAS t ER JA'o b- 1.;. v A LO'K POOL I.QUI M&N '7 .t A` CGl SUR ! 0 .CVM 1' .
MIX DED,
. 5°1' ' KU (0 OF CO:N'91"R.>U' '? :ON
g pry a e p 9 r 'p a
1F'A7 R)1 '. 'tC .il' .SiE 67i1i4 MARY
PLAN CHEM, PER 1X05
C' O7?bS1:°R.i3rw'I;'.ION.FEE 1.02Po000-410-000 $11s00
MWR'. 2V CAL, 14,411, — P001, 101.000-321.000 $24,00
w .) C'F'RK AL« M — PC3LZ.L ' ' ] 01.000-4'20-000 $ 13,9fp
PLOWAD40 FEE- P00t,, 10 * -*000.419.000
MYD-TUTAL c",14-MMUCTIC)X AND JPLA14 CHFPS.
$209.05
LESS FRE- "Ai131yMI
$f)M ,
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RECEIPT
DATE
f is
BY
DATE FINALED
INSPECTOR
sti
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
Underground Plbg. Test
Final
PLUMBING APPROVALS
Gas Piping
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:
1
PJ T _HOMES
FAX NO. - 7605646505 ;; Oct. 17 2000 02: 57PM
P10,
" City of La Quinta ^ r
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Building u Safety Dlvislon
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P.O. Box 78.495 Calle Tampico
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,1504,
La Quinta, CA 92253 • (619) 777.70-12
,
wilding Permlt Appilcatlon-and Tracking Sheet
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per's Name: m
RJT Hoes; LLC
rte/ '^
Address: PO Boz 810
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- Cit• $T, Zi
Y, P: La Quinta, CA 92253
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Its
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RJT Inrestments, Inc
Tclephonc: (760) 564-6555
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• Ia15 E. Unlversity Dr.
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Pro}cct Ocscription: ^
s 741
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21p Phoenix, AZ 85034
-•• 690645
City Lic, a: 4990
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_ . •: Cont:cc Pcrson: ' Chad Sq
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