0006-256 (SFD)79365 Mandarina
0006-256
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# C e,Lic. Cr llass Exp. Datte/r9n prr
690645.. .6+.Ci CA. 06!30/24
Date -11 -62 Signature of Contractor' 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'
compensation, as provided'for by Section 3700 of the Labor ;de, 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:
Carrier INS, COMPANY Y OF T Policy No. WD9170041900
(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.
Dater Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is .
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent), :'f ` ` f Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT
Q1C,1,3dp 13
TRACT
2 4R1-
l4 7. ra
JOB SITE
ADDRESS t 6 ^5t* I i1rJIR rI ,fs
APN
7% -•003
OWNER
CONTRACTOR/ / EN (NEER
I3T I C.
DEDEtSIGNER
14.25 E INIV:I `I1'YY:t3PJn
1425 F_ CTMINT— Y DRIVU
AFI®'i IAC AZ 85034
PkTOUMC
AZ
83034
(601)237.1656
CMIJ
4990
USE OF PERMIT
SKU i3OT 1 Pt € N IRA PERMIT tJtiF i NOT fNCl, U )F HLOCK WALLS OR
POOL,
T
CUSTOM CONSTRUCTION 2,450,00 8F
PORCWPATIO 11$.00 Sig
GARAGE/CARPORT (OF) 12,260,60
1%1
E1Vff1 XrfW cosi OF CON$lfR"WrlO.11T
,l 72.2[D
16T.FNE 11UMMARY
C (
CONSTRUCTION THEE 101-000-418-000 S1,D114,00
Pi Aid CHECK hi E* 101-000-439-31$
MECH"ICALF.0 101-000-421.000 $105,00
E1. FCTRICAL PER 101-000-420-000 $156.47
;-0
PLUMDING 101-000«419.000 S180130
STRONG MOTION F70 - RESID 101-000.241-000 W.62
ORE4DING FEE 101.000.423.001 $20.06
DL?VE1..OVER.IMPACT 1 $1,907.00
ART IN PUBLIC PL.ACFM - RESI.L 701.0011',255-000 SI5<43
SICIB-TOTAT, CONWRIJCrION .A13D 1'1." C1 ;K
$4,2,14,52
1,F33 PRE -PAID WE, S
$0.00
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
-
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
/6' �O-ca
Drywall - Int. Lath
Final 2 d
Final
�..y j. Q ��
POOLS -SPAS
BLOCKWALL
APPROVALS
Steel
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 Plaster
Sewer Lateral
' - GU
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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)Q=CE
fermi m
FAX N0. : 7605642238 Feb. 21 2001 11:24AM P2
0"
s ClpOF LA QUINTA
811 -biNG & SAFETY DEPARTMENT
777-7012
j N 2 7 ZMPECTION RECIUEST LINE
777-7153
r"
,r --PT. .
F ' kA',IN'V'E TMENTS, INC
Contractor RJT INVESTMENTS,INC
Permit Number
0006-256
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL'APPLICABLE SPACES
JOB ADDRESS 79-365-M,ANDARINA.
SFD- LOT 13 PLAN lIZA PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL.
FOOTING
MAIN GR(
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAP BEE IGNeu
CONCRETE SLAB v '
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
Io.: NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST !
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM '
O.K. TO WRAP
GROUT O 4' 0 8' - G
FRAMING lk
INSULATION D6
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
SWINEFISEPTIC TANK C^
FINALS
• ELECTRICAL • / ) 0
... .,,TI NO - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPYBUILDING
n
Certificate-ofOccu'pancy
City Quinta
of La
Ixain,u 4'
Building and Safety Department. Oaf''.ti
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,.
certifying that, at the time of issuance, this structure, was in compliance with the various ordinances
of the City regulating building construction or use. For the following;
BUILDING ADDRESS: 79-365 MANDARINA
Use Classification: SFD Bldg. Permit No.: 0006-256
Occupancy Group: R3 Type of Construction*: VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC Address: - 1425'E.. UNIVERSITY DRIVE
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Dater 2-21-01
Building Official
POST IN A CONSPICUOUS PLACE