0010-163 (RPL)79365 Mandarina
0010-163
i
LICENSED CONTRACTOR DECLARATION
AI_hereby.affirm under penalty of perjury that I am licensed under provisions of
Xnapter 9 (commencing with Section 7000) of Division_3tof the Business and
'Professional§ Code, and my License is in full force and effect.
License # Lic. Class . Exp. D to e
Dater >
Signature of Contractor fry `• - ' "" ~~' °
Ile 4"
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'
coompengation, as provided for by Section 3700 of the Labor. Code; for the
ppe 6rmance 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 Policy No.
STATY, 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,
1 shall not employ any person in any manner so as to become subject to the
workers' compensation laws of Califo"rnia;'and agree that if I should become
subject to the workers' compensation,provlsions of Section 3700 of the Labor
Code I sbagl4orthwith comply with those provisions:'
Date - a , 4r •/ 'Applieant `9'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal'penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the 'conditions and restrictions set forth 'on his
application.
1. Each person upon whose behalf this application is made & each person -at
whose request and for whose benefit work is performed under or pursuant to .
any permit issued as a result of this applicaton agrees to; & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application"and state that the above information is
correct.,l agree to comply with all City,/`and State laws relating to the building
construction, and hereby authorize..represen66es of this City to enter upon
the above-mentioned°property for.°in'spectirjn purposes. ,r
Si nature 'Own er`/A ent)A- '-ate- Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT j { TRACT
JOB SITE '
APN
ADDRESS cvt X eA y q yr, A
aJ'"3 ,:! aF: .i-:dv. if,Pi1 .4I5.0.YmA
..
,OWNER
CONTRACTOR / DESIGNER / ENGINEER,
ids"l 1 .0bol- -S, :C: C
i l l d'. .. m11• d' f WC.
P. C), BOX 810
1425 R, i :kJ 1710.117 3RNE
f.. QI;37 4TA CA 9225:3
1 HOEMEX AZ 95034
(602.)257-I155ra CB 990
USE OF PERMIT
POM JMgVOR SPA
1 CSS31a SF' a?el liLtL941t1ft 1tJI ;a SHALt. WE IN P AM AT PJt.&PtJ ° ER.
'1 3P90T1'ON, POOL FQUIPI tX14T 'Y °l i•CL0 3tlRF 4A A40 IHe,'ATD. D. 1
POOL ANDIOR SPA a oo , c 1
ESTIMA7W C ,3b W 5.0XI ".X" J' C,". ON
1010W.00
1'1. M CREC1K FEE 101,,000..4x9.31 U S,l.0
C$D.3dS'T1 UCTION FRE 1i3',d-000-418-Sa00 $117.0
MEG°KAHICAL ''?E•ft -- POO L i L1 Q 00,4211.000
p_1„ 'rR1C.. i,t.. T9. POOL 101--000,4 0-000
rPUt INO FEZ •- POOL 101--000-419-000 S217106
4Y Y
AIN i)TAL C01 F,,i1 TJe. ON AMU) PLAW (-,kl F '
$299.05
3',.yq*a M -PAID 1"M
$0.00
lilt
x
RECEIPT
DATE'. !
BY, ,,
DATE RNALED
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
Set Backs
steel
Electric Bond
POOLS - SPAS
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
Gas Piping
_
•
PLUMBING APPROVALS
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
Sewer Connection
Pool Cover
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 RJT-HOMES FAX NO. 7605646505 Oct. 17 2000 02:54PM P6
'
PERMIT FEES
Deposit
J.
R 9-111i
City 'of La Quini
P.O. Box 1504, 78-49S Cal -le Tamplco
La QuInta, CA 92253 - (619) 777-7012
Building PermIt Appk'atlon and Tracking Sheet
01111"11 Namc:'RJT I-I'mosi LLC
Ci(Y,ST, Zip: LA Quintli, CA 92-253
RJT Investments, Inc,
1425 E. Univtoity Dr.
Z,p Pnoenix, AZ 85034
690645
CiiY Lic. 0: 4990
— Oaljoor List
,Ir-jclor Into,
kimmFCOUTUCtion
Type: guw"A — Occupancy:
Project tym f(,irclle ont N w ' Add'n Aller Rcpb,(
Pctson. Chad Mem
Sq. Ft.:
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APPLICI NT"
.7
PERMIT FEES
Deposit
J.
R 9-111i
— Oaljoor List
,Ir-jclor Into,
Approval
1)(PI. Approval
PERMIT FEES
Deposit
J.
R 9-111i
rT i_-OMES
•
FAX N0. 7605646505 Oct. 17 2000 02:55PM 07
SEE
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