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RPL (0008-430)79475 Mandarina 0008-430 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. YClass Exp. Date d g + 69 aYuS . D 11-11C 6"► Date Signature of Contractor _ :A 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 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 I.NS, COMPANY OFT Policy No. WIM170041900 (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 Orth ith comply With thos ,provisions. Date: Applicant Warnin : Fe ure to secure Workers' Compensation covers „ys- nlawfuI 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 succi 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 forin,pection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# 3 DAT ( t, VALUATION LOT 0"-430TRACT i JOB SIT .erf. ADDRESS -7914759 APN YY• >a .l; . .MA OWNER CONTRACTOR / DESIGNER / EN (NEER PTI, 110 LLC = Mr rMuln, INC. PO BOX 810 14251R,1.1N1VM''1TY =VY. LA QUJINTA CA 92253 PHOE=' AZ 85034 (602)Z57-1656 CBL# 4990 USE OF PERMIT POOH, MWOR SFA POOL, & ;PA ONLY-ALAIWMARRIERS SHALL BE IN PLACEAT PRE P1lAS`t M. IS NOT MCL[ DED IN THIS PERMIT POOL. ANDIOR IVA 10„000,00 LS 11AAM CONT 01' EC1 ls7cON 101000.00 C .Rdl. PLAN CHECK FEE 101.000.4.39-318 $70.4$ CONSTRUCTION WE 101-000-418-000 9117,00 MECRANICAL FEE -- POOL 101-000.421000 $24.00 W.&CTRICAL IEEE •• FOOL 101 -OW -420-660 .. $45,00 PLxIMBINO WK •- POOL 101-000.419.000 `' $27,00 WA -'1'©,M. C0k48TRUC110*0` fiNS'+ PL.R1 ' c''IMCK $289.05 LPSO FRE -PAID F00 $0.00 RECEIPT DATE BY D NA E4 .1 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 OX 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 '7_ C,—, 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 Gas Piping Gas Test Appliances Final Z 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 : RJT_HOMES FAX NO. 7605646505 Aug. 30 2000 03:34PM P5 j7 q Al � ..",""'�•."'". ;;1, woolme, ;. y� OV •9 �• .,. Yrr • y�. Q5 r ~ _ 1• ,2"9t 6' 6E"Odd FG� Poco R� �NSPE E F jNE aePN °N. W08Ec�0 g CPRo O vlOgS� QEC� oP-�E 1NS pF� R 3OdNnO C azunoo 0. NOA l'HS NO - X30NI ..r•. 05/01/2002 08:44 7605646505 as � CITY OF LA QUINTA c�P BUOING & SAFETY DEPARTMENT 777-7012 �- INSPECTION REQUEST LINE 777-7153 owra�`, RJT !!p S LLC Contractor RJB INVESTMENTS INC P�Mk' Number 0008430 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 79-475 MANDA NA POOL & SPA, ONLY-ALARMSIBARRIERS SHALL BE IN PLACE AT PRG PLASTER INSPECTION. POOL EQUIPMENT ENCLOSURE IS NOT INCLUDED IN THIS PERMIT TYPE OF INSPEG"ON DATE INSP. FOUNDATION 8 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 L, AOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST (( HEATING & VENT- A/C FIREPLACE ROOF BOND BEAM O.K. TO WRAP -lit-INSFECTMI-M -Ur GROUT Cl4' 0 8' ILL BE CHAF G 0 F TH APPRB FRAMING INSULATION PRE -ROOF COVER NO WORK UNTILj8,HXS%GEEN SI DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE U v SEWER SEPTIC TANK FINALS -MINIMUM OF 2" BELOW WEEP SCREEDS.