SFD (0006-255)79375 Mandarina
0006-255
LICENSED CONTRACTOR DECLARATION
0wherebyaffirm 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
i
690645 RMC A. , 'r (96/;3012(
te. F ~' Signature of Contractor a'} `l" t
J el
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 Sianature 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
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 114,13, 60MPANY OFT Policy No. WDR170041900
(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. rn
Date: 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 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] 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) --``-- Date7`'
BUILDING PERMIT PERMIT#
DATE .-r VALUATION LOT 00"-255
• ( U $214,05SAO 12
TRACT
26447.2
`! .
JOB SITE
APN
ADDRESS 74-375 1V ANI?ARffl 'A
7
772-060-MOWNER
CONTRACTOR / DESIGNER / EN &NEER
R3 I :[k W,'BTMEaNTM, Iki'C,
RXf WVESD fMTS,
INC.
1425 R VNIVERM'Y 17RNF
1425 ,. & UNI'VLMSITY MWE
FIRM= AAS; 85034
PHOEM
Ay.
g5C134
(602)257,1 56
MIX
4990
9
USE OF PERMIT
SINGER FAMLY lYiniF,L M13
SFD- %.OT 12 P"W 2B PERMIT DOES NOT INCLUDt; BLOCK: 'WALE OR
,
POOL,
'
'd
w
CUSTOM CCUSTRUCTION 2S'na s
POR.CHIPA.TIO 203.00 SF
#
GAR•AGEICAFt.PORT C`dI) i 1,4001 20
..,
i„..t
RS I12D C05' Or CO3N'5'J6RUC'1” 0,K
.2i1' AW.40
MMU 1 U FEE Mi7IM
CONSTRUCTION FEE 101-000-418-000 $1,042.00
PL&W CHECK WE 101-00"39-318 $937.87
.ME'C13AN1CALIIZI; 101.000.421<000 $111.58
1? ECTTICAL FFZ 101-000-420-000 $139.34
PLUMBING ItUJI 101.000.419.000 $1600
STRONG MOT1014 FEE. RESID 101-000-2+41-000 $31,49
IOR&DR40 FIEF 101.000.42.3.000 320 00
DEVELOPER IMPACT ME ! SrOA 00
ART I.1J PUBLIC PLACES - UP Sit 701.000-$55.000 W. i4
SUB -TOTAL CONVI:RUiC;`l'iON AND PLAN CHECK
$4,,336.ft
I° °' PRE -PADS FM
50.00
'4,'436.84
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
N
4N
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- CU
Underground Ducts
Forms & Footings
-cf, 6y
Ducts
Slab Grade
—co
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
GCS
F.A.U.
Framing
AnOd
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
POOLS - SPAS
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
_ _ Q9
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:
IN
FROM FAX NO. : 7605642238 Apr.'27 2001 09:41AM PI
-AlblTY- OF LA QUINTA
i .. ` ( ; BUILDING &'SAFETY DEPARTMENT
777-7012
lot
INSPECTION REQUEST LINE
777.7153
f -Hyl, INvEsTmZNTS, INC
o
Contractor RXr UWESTMENTS, INC
Permit Number
0006-255
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-375 MANDARINA
RE
JOB "A"b"b- ,qs,
SFD- LOT 12 PLAN 2B PERM T DOES NOT
INCLUDE BLOCK WALLS OR POOL.
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
tF;0 8 TIN G STEEL Gel
MAIN GROUND SYSTEM
GROUND PLUMBING rZ 742
PRE-GUNITE
Do NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS a GIRDERS
ELECTRICAL GROUNDWORK
bi -NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
-ROUGH PLUMBING
_Z7
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
01
O.K. TO WRAP
GROUT 0 4- 0 a,
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH 71
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
PLUMBING
L GAS TEST 7-
.., , TING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
00 NOT INCLUDE RIGHT TO
'n ION nN -1 Ml ITIOR AR 6r.f-I ]PY Al 11MIN(l,
lr
"Certificate I of Occupancy
City of La Quinta
Building -and Safety Department.
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:
Use Classification: SFD
79-375 MANDARINA
Bldg. Permit No.: 0006-255
Occupancy Group: R3 Type of Construction: -VN Land Use Zone: RL
Owner of Building: RJT INVESTMENTS INC
.-Building Official
Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 4-27-01
POST IN A CONSPICUOUS PLACE