RPL (0008-436)79415 Mandarina
0008-436
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
C_apter 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
69064.5 B HIC A., 07 C
Date Signature of Contractor
OWNER -BUILDER DECLARATION
1 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 Code, for the
peyrtpfmance of the work for which this permit is issued.
C ) 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 IN$. COMPANY Ol, T Policy No. WDE170041900
(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 th t if I should become
subject to the workers' compensation provisions of Sect on 700 of the Labor
Code,I fo ith comply with thos rovisi s.
Date: Applican
Warning: 'ailure to secure Workers' Com pensati a e verage 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 representative of this City to enter upon
the above-mentioned property for,inspection urpo
Signature (Owner/Agent) Date
BUILDING. PERMIT PERMIT#
DATE f• 'J.' % j11 VALUATION LOT 0"-4.'3fr TRACT i
JOB SITE
APN
ADDRESS 79-41S MANDARMA
OWNER
CONTRACTOR/DESIGNER/EN (NEER
M HOMn LLC
R3 'ilTwti#iwwrs,1NC.
I 1 BO X 810
1425 R Ul-IN13RB "Y DRIVE
LA.QUINTA. CA 92253
PHOENIX AZ 85034
(602)257-1636 Cox.# 4990
USE OF PERMIT
POOL ANDIOR SPA
POOL &SPA ONLY•ALA1 AAMARRIERS SHALL BE IN PLACE AT PRE
PLABUR 1NSPEC i'IOKPOOL EQUIPMENT ENCLOWRE IS NOT fKCLUAEO
IN THIS PEP -MIT
POOL AND/UR SPA K000.00 Ls
EFIE"T10 COST 01° CONS"'i UCnoff
10,0W.00
P:esit11JlTlM 90bWA 2'Y
PLAN CHECK 17EE 101.000-439.318 V&05
COi STRUCTI013 FEE 101-000-418-000 $117.00
W.CHMICAL, FRY, -- POOL, 101-000-421-000 $24.40
EL ECfRICAL FEE •• POOT, 101-000,420-000 $45.00
PLUMBENC3 FEE •- POOL 101.000-419.000 $27.00
81TWrOTAT, C"C7M 1'AUCTION A4-11yy F :i yy ll l C wl qq .?//C+:Kry ,
$2€8y9.05
yy{ vv 77
d.fl7M . RS—.C1ATD.C.1 ^CH7
dJa00
$ t. :,T TATIJ PEMMI DUDE: NOS
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RECEIPT
DATE
BYl
DAT ALED
-2—O
INSPECTOR
a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
1612 -Gel
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
Pool Cover
Sewer Connection
Encapsulation`
Gas Piping
Gas Test
Appliances
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)
Final
COMMENTS:
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PAGE 03
C Y OF LA QUINTA
k
v, . 8UIL NG& SAFETY DEPARTMENT
"11 777-7012
1
.-
O NSPECTION REQUEST LINE
Owner
Cor rador
. . 1 ZD 777-7153
RJT-ISS LLC
R.TT INVESTMENTS INC
Permit Number
0008-436
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-415 MANDARiNA
JOB ADDRESS
POOL & SPA ONLY-ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE PLASTER INSPECTION- POOL
EQUIPMENT ENCLOSURE TS NOT INCLUDED IN THIS
PERMIT
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
[:,:•AOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING Gc1 !yam
ROUGH GAS & GAS TEST ! I
HEATING & VENT • A/C
BOND BEAM
O.K. TO WRAP
GROUT Q 4' O S'
FRAMING
INSULATION
PRE -ROOF
DTIMIC
hl COVER NO WORK UNTIL A EN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER ' -
POOL FENCE & GATE
SFWFR SEPTIC TANK
ELECTRICAL
PLUMBING
FINAL GAS TES
JOB COMPLETED
TEMP POWER ;; 1N RK SHALL 13E PLACED A
MINIMUM OF 2" BELOW WEEP SCREEDS. .R