RPL (0008-429)79485 Mandarina
0008-429
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
Prgfessionals Code, and my License is in full force and effect.
.`. License# Lic. Class Exp. Date
D MIC 0112E
Date Signature of Contract
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.
(apf jl 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 4215, COMPARY OFT Policy No. WDE110041900
(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 f tion 3700 of the Labor
Code, I ski I fo hwith comply with those provisi S.
Date: q 1 - Applicant
OF I
Warning: Failure to secure Workers' Compens Ion/coverage is unlawful and
shall subject an employer to criminal penalties an7 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 nulliand 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 represe tatives of this City to enter upon L,,„
the above-mentioned property for inspectionfirirposps.
Signature (Owner/Agent)' Date
PERMIT PERMIT#
OB,ILDING
LUATION
LOT OM -429 TRACT
$1104=1.00
JOB SITE
APN
ADDRESS 7-9-485 MANDMIZINA
OWNER
CONTRACTOR / DESIGNER / ENGINEER
xr HOWS UIC
RA WVW tVlE.'NS, WC.
PO BOX 8100
1425 X 11 MY DRTSt'11
LA QU"IRrA
C'.A. 92233
PHOMX AZ
83034
(602)257-106 CEMf
4990
USE OF PERMIT
POOL AloT1, MGR OPA
POOL &-S*PA ONLY-ALARMS/1 ARRIVRS SHALL 8F IN 01ACL AT PRE
PW t ER IMPGC! 10N,P0OL EQUfPME14T ENCLOSURE 1•" "NOT INCLUDED
IN THIS PERMIT
POOL AND/OR SPA
1%000100 L9
or CO)7i6'MUMON
10,4 00.0119
PK1'x' 13 ~ ' WWAARY
PLAN CHECK FEE:
101.000-139.318 $76,03
CONSTRUCTION FEE
101-002-11.39-000 $117.00
MECHA141CAL PEE -- POOL
101 ^000--421 --000 $24.00
ELECTRICAL H'PL --POOL
101-000.420-000 10.00
1'1.,tlARfl4}IG PEE --'POOL
101.000.419.000 $27,00
OUB-11WAL CON.`+"1RXXTION fi dM PLAN C°fE
$289.01
LESS PRE-PAU) AM
SAm
'SIAL l'k'I21 M' MX WE NOW
.05
RECEIPT
DATE
BY 4
DAT;I AL
INSPECTOR
INSPECTION RECORD
q4 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
POO - SPAS
steel ez .>
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric -
Underground Plbg. Test
Final
Gas Piping 41
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 Gil
Gas Piping
Gas Test
Appliances
Final — G(
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 : PJT_HOMES FAX NO. : 7605646505 Aug. 30 2000 03:33PM P3
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RJT HOMES, PAGE 02
5 � 1
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QITY OF LA QUINTA
cor po BUFL�7ING & SAFETY DEPARTMENT
777-7012
,A®INSPECTION REQUEST LINE
777-7153
6V RJT--!t0_tWXS LLC
Owner.
Coi"ctor RJT INVESTMENTS JNC
Permit Number 0008429
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79485 N ANDARINA
POOL & SPA ONLY-ALARMSBARRIERS SHALL BE IN
PLACE AT PRE PLASTER INSPECTION. POOL
EQUIPMENT ENCLOSURE IS NOT INCLUDED IN THIS
PERMIT
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
MAIN GROUND SYSTEM
GROUND PLUMBING
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEE
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
's
D :.SNOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING Q
ROUGH GAS & GAS TEST
HEATING & VENT - A1C
FIREPLACE
ROOF
BOND BEAM
O.K, TO WRAP 4 3
GROUT O 4' ❑ 8' WILL BE C iARGED
FRAMING PI ANC ANrl Ink
PRE -ROOF
FINALS
FINAL GAS TEST
71 NG - A/C
SE NUMBERS
JOB COMPLETED —
TEMP POWER
—ALL CONCRETET AT Wo V79FFALL BE PLACED A
jflINIMUM OF 2- BELOW WEEP SCREEDS.