RPL (0008-434)79435 Mandarina
0008-434
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
cha: tffr 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
69 15Q'I BMC A j K /A i 1/2(
Date Signature of Contractq(
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 Code, for the
performance of the work for which this permit is issued.
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 WS, COMPANY OFT Policy No. "a1 DS17004AA00
(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 Se tion 3700 of the Labor
Code, I shat forlhwith comply with ihs rovisions.
Date: WN63co Applicant 22 A
Warning: -ailto secure Workers' Compensation cov a 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 propert for inspection • urp . es. Q'
Signature (Owner/Agent ° f 117 Date r
`BUILDING PERMIT PERMIT#
,,. ````Jn
DATA, VALUATION LOT TRACT
yr
1.
t $I ty,OtN3.t10
JOB SITE %
APN
ADDRESS 79-4,wT%AwrfA
OWNER
CONTRACTOR/DESIGNER/EN (NEER
RN HONM LW
RJ11ATV
;PO 110X. 810
1425 E. VNWI MSITY D;4'U.VL
LA QUINTA CA 92253
pi4omux AZ 85034
(602)257.1656 CBLO 4990
USE OF PERMIT
POOL AN-,?IOR SPA
POOL &- SP.A. ONLY•AW+RMSffiARRIERS5HALL $i: IN PIACE AT PRE
PLASM, INSPEC s rOrKPOM EQUIPMENT ENCLOSURE 19 NOT MCLi DED
AN THIS 1aE43MIT
POOL ANDIOR.SPA M0KPO US
F; 1 MA 7 a COST OT CONYMUC310K
101000A0
rklwr PRE 9171An:i ARY
PLAN CHECK FIE 101-000.439.319 $76,05
CONSTRUCTION WE 101-000.41$-000 $117.00
VIEC ANICAL FEE •- POOL 101-000-421-000 $24:00
ELECTRICAL VP.3.' -- POOL 101-000-420-000 $45.00
PLUMBINC3 V29 • POOL 101-000.419.000 $27.00
911B -TOTAL CON91RUCTIO14 AND PLAN CHS:
$289.05
LAS PRE -PAID MRS
10.00
IT TOM 1"IMMn''MIN DUE NOW
RECEIPT
DATE
BYE ^'
DA ,E -FI LED
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
0. 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
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
Pool Cover
Sewer Connection
Encapsulation
. c -d'
Gas Piping
Gas Test
Appliances
Final
-2—
COMMENTS: 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)
FROM RJT_HOMES FAX NO. 7605646505 Aug. 30 2000 03:39PM P13
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RJT HOMES PAGE 04
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Cl Y OF LA QUINTA
c. .BUILQI1 ia & SAFETY DEPARTMENT
Op
777-7012
gSPECTION REQUEST LINE
" 777-7153
RJT HO1S LLC
Owner ►-
Con&,c or RJT INVESTMENTS INC
Permit Number 0008-434
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-435 MANDA.RINA
POOL & SPA ONLY-ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE PLASTER INSPECTION. POOL
EQUIPrvMNT ENCLOSURE IS NOT INCLUDED IN THIS
PERMIT
TYPE OF INSPECTION DATE INSP.
FOUNDATION B SETBACK
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE WAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
IL_AOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING ) 77__
ROUGH GAS & GAS TEST ( /
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP N FtE OF $30
{ Hf AP ROVE
GROUT ❑ 41 ❑ 8'
FRAMING PLANS A 0 108 CARD- RE 101 N
PRE -ROOF
COVER NO WORK UNTIL AdbVtWi MN SIGNED
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
FINAL GAS TEST
;TING - A/C
SE NUMBERS
J06 COMPLETED
TEMPALLvt;U LER ;Kr I t -LA I w KK 'HALL 15t P ACED A—
MINIMUM OF 2" BELOW WEEP SCREEDS.
I