RPL (0010-164)79355 Mandarina
0010-164
LICENSED CONTRACTOR DECLARATION
rei hereby affirm under penalty of perjury that l 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 d
License # Lic. Class JJ Exp!Date
i
,pate" 'Signature of;Cont act r
t J'
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 (Seca 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 ,orr4nce of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
t1on 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.
STATIF FUND
(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 manger so as to become subject to the
"'workers' compensation laws of .Calif6rnip, and a`gre'e that if I should become
subject to the workers' compensation rovisioris f Section 3700-pf the Labor
-Code, IdshalV with comply Witt ttao a provisions.
fate: jf `v a. r.• 1''Appl'iantAJ
Warning: Failure to secure o kers' 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
1.correct. I agree to comply with,all-City, and State laws relating to the building
construction, and hereby authorize! epresentativ'es of this City to enter upon
the above-mentioned✓ property forrin'spection purposes. '
Signature (Owner/gent) ., Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT M10.464 TRACT
JOB SITE
APN
ADDRESS
79-3,10AWMAMMA r
-
OWNER ' ;
F.
CONTRACTOR / DESIGNER / EN (NEER
:><d.3s'"MGM &S` : C `
' iwti':I:ummm,1NC.
P.O. BOX, 810
14 25 IL UMMMY DRIVY,
.f,,A QUU b3l"A CA 9225'3
PH<, ENDC AZ 95034
(602)257K 1.636 01114 4990
USE OF PERMIT
//L AND/OR
POOLRA;
i
11100USP.illk. ,A.L,ARIM:3MAR#t,f ZS S.Fi •Id HE IN PLRiC..? AT PPXaVLA J fit
ED,
KOj?WTION, POOL 10,UilaVMR;;fFN(;'t0511RE fS NOT 0,41CLUDED,
:PNDI, ANDIOR SPAi?111, i
PLAN CHUX FU 101.000.439.018 105
CO ISIi'RUC IGH RX 101-000.418-000 $11700
$24.00
MECHANICAL F 1t rE •pw 1 ' {.3OL 101-000-421-000 $24.00
A 1, F,C'3.6 .ICAir VET,'., •- P001a J J L "•>l iV•'W GM1'"ViAU $45.00
n4.1msrkaf,It'. poo, 101.000.419-(t00 $27,00
y p yy 9'J g , q y( gyp y4 .y
4.•eJ V!:13RUC5 FIJSU l iV1. JR',l t'1.[V +..FY.' rl.r +w
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$0.00
OCT 6 D' OW
$ .
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Y
RECEIPT
DATE
BY rt
DATE FINALED
INSPECTOR
.f
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
Set Backs
Steel
Electric Bond
POOLS - SPAS
/_/ _
l 7
Footings
Main Drain •
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
PLUMBING APPROVALS
Underground Plbg. Test
Gas Piping
Gas TestElectric 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_10,
_
j!!! : -
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
f
V
RJT_HOMES
FAX NO. 7605646505 Oct. 17 2000 02:55PM P8
1
City of La Quinta
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Bulldin%&Y Safety Dlvlalon
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,.rm.; 17
P,O, Box 1504, 78.495 Calle Tamplco
y , VA
La Qulnta, CA 92253 • (619) 777.7012
Building
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Permit A li
pp cation and Tracking Sheet
.cress 79 _•
tltci'
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Owncr+s Namc:'RJT Homes; LLC
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77;--06
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Address:
►11
PO sox $10
City,ST, Zip: La Quints, CA 92253
RJT Investments, Inc.lnc
—,Telephone:
(760) 564.6555.
r
1425 E. University Or,
,—..
Project Description:
tg
Z;p Phoenis, AZ 85034
(60?) ?57.1650
•1
690645
Ciry l,ic, q: 4990
Construction Type: Ocan
ctt P cY
111
r
Project type (circle one)Nov Add'n Alicr Repa :
.
Comm Person: Chad
Meyer
Sq. 1'l•;
p Stories:
d lJnits
•.. of C°^tact Person: (760) 564.6555
Estimated Value of Pr ojcci:
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