RPL (0008-437)79405 Mandarina
0008-437
LICENSED CONTRACTOR DECLARATION
['hereby affirm under penalty of perjury that I am licensed under provisions of
!z-hapter 9 (commencing with Section 7000) of Division 3 of the Business and
f-rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
69064• 'B MC A /01 X
Date Signature of Contractor
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 -
() 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
performance of the work for which this permit is issued.
( ber ave 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 TNS, COMPAVY OF T Policy No. - ; VDF,170041900
(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,'l sh II fortwith comply with tose provigions. ;
Date: Applicante. t1
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.
a
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) Datef l- a
BUILDING PERMIT PERMIT#
ONS -4.37
V/ /
DATE TRACT
) •VALUATION LOT
glomoo
JOB SITE l
ADDRESS "_4o 1
APN
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
PUT ROlbtMLLC>
.f, ", TNVF&naAd'f-3, INC.
PO DOD 810
1425 L , ITN7:Y'.t Say DJUV'L
LA QTJJ 1` TA CA 9.2253
P14C5WIX AZ 85034
(602)257.1656 C1 4990
USE OF PERMIT
POOL MWOR SPA
POOL &SPA ONLY-A1.-WASMARR.IERS SHALL DIE M PLAC:O,AT PRE
PW,TER M'-9PRC T TCJAi.P00L WU1PMFW T 8,11CLOSURR 19 -NOT INCLurwo
M THIS 1PEMMIT
POOL AIj1WOR SPA 10/000/00 Ls
'
0M 1l IM) c0tv, OF CO.Z 911RU(IMOPT
30 '/,031
M,' 51'11 FEE MMMARY
PLAN CHECK: FEE 101-000-439.318 S76.0
CONSTRUCTION PER 101-001-418•-100 $117. go
MECHA141CAL RX, -- POOL 101-000.421.000 $24.00
ELECTFUCAL FEE - POOL 101-000-420.000 $45.00 .
PLUMBING RIE .- POOL 101-,000.419.000 827,Q0
a
8-Ob-T)TI AL CION} I)CLION AND PLN M1RM
$78.9.05
LESS PRB-PARD f< 3.`1
$0.00
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♦ .c P. 4'0:01 4L I'M.,CN T 1IMS DUE NOW89.05
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K4'
RECEIPT
DATE
BY %% f
DATE INALED
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
Steel
POOLS - SPAS
4 .� — cd
Set Backs
Electric Bond
4:e/1
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Z p
Underground Plbg. Test
Final
Gas Piping
44
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
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:
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bid Wdpb:F0 0002 02 '6nd SOS9b9S09L ON Xdd SdWOH-ifd W08 -J
05/02/2002 08:33
7605646505 RJT HOMES
syr
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
F,
of 777.7012
REQUEST LINE
QIECTION
.I
777-7153
MES LLC
I '?
Owrm t
pQMTMENTS INC
Contractor ;
' - -6008-437
PoVft Number
POST ON JOS IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-405 MANDARINA
•
JOB ADDRESS
POOL & SPA ONLY-ALARMS/BARRIERS SHALL BE IN
sI
PLACE AT PRE PLASTER INSPECTION. POOL
i1
EQUIPMENT ENCLOS10RE IS NOT INCLUDED IN THIS
�i
PERMIT
TYPE OF INSPECTION DATE INSP,
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
:i
GROUND PLUMBING
PRE-GUNITE ok
;...
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS A GIRDERS
l
ELECTRICAL GROUND WORK
"!
OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNEID
! 1
ROUGH ELECTRIC
ROUGH PLUMBING Q O �✓�
ROUGH GAS 8 GAS TEST
HEATING &VENT • A/C
.
FIREPLACE
ROOF
Y
BOND BEAM
j, j
O.K. TO WRAP I S O#FEEOf 30
t!
GROUT O 4' ❑ 8'
i
FRAMING W) IAB C—ARIM All
INSULATION r
E FOR A S
PRE -ROOF
COVER NO WORK UNTIL A8 IGNED
`!
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER r
POOL FENCE & GATE.
SEWER SEPTIC TANK
• i
FINALS
ELECTRICAL
PLUMBING
' !
FINAL GAS TEST
{i
>rti;(ISE NUMBERS
JOB COMPLETED `J
:f
TEMP POWER
trALC•BE•PLA ED A_
:#!ALL
MINIMUM OF Z" BELOW WEEP SCREEDS. _