SFD (0006-252)79385 Mandarina
0006-252
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 # Lic. Class Exp. Date
690645 B IHIC A`
VDatej f4Z += Signature of Contractor
OWNER -BUILDER DECLARATION J
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
I•
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 3700of the Labor Code, for the
performance of the work for which this permit is issued.
( )f I have and will maintain workers' compensation insurance, as required by
Se'ctign 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, C'OMP.A2SI`i'' OFT Policy No. `i DE170041000
(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
C,, ode, I•shall forthwith comply with those provisions.
v Bte:.E '; r, r ,, Applicant •. t-)
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.
j ! s 1 / w •••-
Signature (Owner/Agent)-,--= r` •* - ,;. . Date
BUILDING PERMIT PERMIT#
4
DATE VALUATION LOT . 00015-252 TRACT
SM3,74€ 40 11
2$4.47.2
JOB SITE
ADDRESS 79— M cMTNA
APN
7724M-003
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RXr IIsi 'Cid t 2J'A: , WC.
RJ I DffE5I°iviWM, RTC.
14251 VNIVEZ.STxY DRIVE
14,25 E. M41VERSITY D RIW
PHOENIX $5034
PHC DaX
AZ
55034
`
(602)237.1656
(MUI
4990
USE OF PERMIT
GJ -E IYA'1dffLYT3WEI.S: WO
3F3:). LOT 13 PLA. -'N WA PTt:i2,MIT DOES NOT INCIZI) B1.,CX.IC 'i+V.ALLZ Ott.
Pt?Ota.
CUSTOM CONSTRUCTION 20833.00 VF
PORCIVPAT10 130.00 SP
10ARAC1I+ /CARPORT (M- 11,323,80
E,1nr.09c OF CONSMUCr fOly
2: x,749,
PERMIT IME Si7MAIIe>,itY
CONSTRUCTION FEE, 101-000.416.OKf 31,1t . 0• .
PLAN CHECK FRE 101-000.439»318 $9tl .a71
MECHANICAL FEE 101.000.421.000 Slaw
EL=TRIC L Fle 101-000-420-000 $168:22
PLUM811HO THEE 101-000.4.19-000 $180.:50
a
STRONQ MOTION FE • RESSID 101-000-241-000 $23.3
GRtAi' IM0 FEE 01.0i30 423.0(if 1;26,a0
a'}
DZVEWPER IMPACT FEE $1,907.00
"' 4
' Nell
li
ART IN PUBLIC PLACIrs • Ro-sir 701-000.295.000 3&1.3!
f
.,w+.
rtq
SUB -3(Y fAL CC REr1tUTEw7rTE)N AM PLAW C fWC'1a
LMS PRE -PAW FE -0
$0.00
1;'ETWf ' ' x'S WERi Vd
-4;"a 2:97
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
a- Gt9
F.A.U.
Framing
Z6 - /Q .
Compressor
Insulation
:Z1
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
1/
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
'�— W
Pool Cover
Sewer Connection
Gas Piping
G
Encapsulation
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) _ or .
COMMENTS:
'JT -HOMES
FAX NO. : 7605646505 Mar. 21 2001 10:50AM P2
Ay OF LA QUiNTA
GRI -DING & SAFETY DEPARTMENT
1.n 777-7012
'ZASPECTION REQUEST LINE
777-7153
.v
vsTMENTS, INC
Owner,
Contra`jT INVESTMENTS INC
permit Number 0006-252
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79385 MANDARINA
SFD- LOT. 11 PLAN 3RA PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL.
MAIN
TYPE OF INSPECTION DATE
iATION & SETBACK
PLUMBING
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB -
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING 8 VENT -A/C
SOND BEAM
O.K. TO WRAP d
GROUT 0 4' 0 8' r
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR LATH .
POOL PRE PIASTER
FINALS
PLUMBING'.
K' 7LGAS T
JOB COMPLETED
TEMP POWER /
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
i;
•f
i
FAX NO. : 7605646505 Mar. 21 2001 10:50AM P2
Ay OF LA QUiNTA
GRI -DING & SAFETY DEPARTMENT
1.n 777-7012
'ZASPECTION REQUEST LINE
777-7153
.v
vsTMENTS, INC
Owner,
Contra`jT INVESTMENTS INC
permit Number 0006-252
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79385 MANDARINA
SFD- LOT. 11 PLAN 3RA PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL.
MAIN
TYPE OF INSPECTION DATE
iATION & SETBACK
PLUMBING
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB -
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING 8 VENT -A/C
SOND BEAM
O.K. TO WRAP d
GROUT 0 4' 0 8' r
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR LATH .
POOL PRE PIASTER
FINALS
PLUMBING'.
K' 7LGAS T
JOB COMPLETED
TEMP POWER /
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
City La Quinta
of
Building anSafety £Md Department o
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
Occupancy Group: R3
79-385 MANDARINA .
Type of Construction: VN
Owner of Building: RJT INVESTMENTS INC
Building Official
Bldg. Permit No.: 0006-252
Land Use Zone: RL
Address: 1425 E UNIVERSITY DR
City: PHOENIX AZ 85034
By: KIRK KIRKLAND
Date: 3-21-01
POST IN A CONSPICUOUS PLACE
ME as