SFD (0004-309)79455 Mandarina
0004-309
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
/ 69064'5 BI:I'iC,A. Ot 0/2(
Date' Signature of Contract , •r'`-'iis «✓
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.
( ) 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 INS COMPANY OFT, Policy No. WDE17M1900
(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 thJo se provisions.
/ mate: / -1 ' - .. Applicant `f
//" o j ...
Warning: Failure to secure Workers' Compehsation 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 r inspection purposes.
71
bg
'nature (Owner/Agent) ent fax /J'...- Date
7r
( g ) 1
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0004,10TRACT
S2.Y4,WkS O 4 21447.1
JOB SITE APN
ADDRESS 79-455 MATq'DA M' A, 772-00)-•W3
OWNER CONTRACTOR / DESIGNER / ENGINEER
RH INVEB"21 NIS, INC. ]RJT 12IVwriv"Im. INC,.
1425 F. UfflWMM..0 DRJVE 14251;, UNIVM0`1I'ff DXIVU
mXOmwc AZ 85034 PROF1 M AZ 85034
(607.)257-1656 CBI,# 4990
USE OF PERMIT
SLNGLEYAMILY DW IrI,: 440
SFD-LOT 4 PI.. 2A PERMITt?C"ES NO T INCLUDZ 'RWCKWA1J,,S OR POOL,
6
Y
CUSTOM CONOTR.UCTIO14 2577,00 SP
PORCH/PATIO 203.00 Sly
GARAGEICARPORi c; M 11,407,20
E.S"M0fAi'%D COST OF C,0V9,MVCf10.T+T
x34, .40
PF,(ZWE FLT SUAO2V
CONSTRUC71ON IEEE
101.000-416.000
$1,042.00
PLAN CHECK WF
101-000.439-318
$07.97
MECHA141CALFEE
101-000421.000
3111150
ELECTRICAL FXF
101-000-420-000
$I5934
PLUMBU40 PER
101.000419.000
81i30;S0
TRONO MOTION FFE - RESID
101 -900-7s1'1-000
$21A9
ORADINO IEE
101-000423.000
$20,00
DEVELOPER IMPACT INE.
$1,907.00
.DRi IN PUBUC". PLACES - RESIr 701-000.255.000
$37,13
SUB -T, OTAL (GATSiRU'Ci 014 "D PLAIi CHECK
1X3.9 PRU-PAf1'? FE&S
RECEIPT IDATE
'I'MAL FEWRI T` W.E.S.` DIA XIDW
DATE FINALED I INSPECTOR
$4,36.83
$0.00
$41311*10
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
, (9
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
.a Ll W
Compressor
W
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
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
Sewer Connection
i _
/ /"
Pool Cover
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:
FROM :
L
FAX NO. : 7605642238 Jul. 09 2001 11:07AM P2
CITY OF LA OUINTA
o£Of BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST O E
777-713
Owner RJT HOMES LLC DOti
Contractor RJT INVESTNXNT , &iI ,.
0004-309)1 T Y' i
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79455 MANDARINA-
JOB ADDRESS
SFD-LOT'4 PLAN 2A; PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL.
TYPE OF INSPECTION DATE I INSP.
4.
Fl11INnATION A SFTRAGK
FOOTING
MAIN GR(
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
L.v NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST G, i
HEATING 8 VENT - A/C
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING I
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR - f C✓ y
EXTERIOR LATH t l / • c ✓ rj
8 GATE
C TANK
FINALS
ELECTRICAL C
PLUMBING
'Al GAS TEST
_ . 1TING -A/C
HOUSE NUMBERS !
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate 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
Occupancy Group: R3
79-455 MANDARINA
Type of Construction:
Owner of Building: RJT INVESTMENT INC
-r,,, #4-.W
Building Official
POST IN A CONSPICUOUS PLACE
Bldg. Permit No.: 0004-309
VN
Land Use Zone: RL
Address:
1425 E UNIVERSITY DR
City:
PHOENIX AZ 85034
By:
KIRK KIRKLAND
Date:
7-13-01
POST IN A CONSPICUOUS PLACE