0007-283 (SFD)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
34283 B f i 0-8112C
Date! ; r Signature of ContractorW131
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
perfoOnce 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 zuRicti rNs, CO, Policy No. per 623996507
(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 h II fo hwith comply wih oe n
Date: 62> Applicant
Warning:
Failure to secure Workers' Compensation 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 prope for on'urp es.
Signature (Owner/Agent) ins
Date
BUILDING PERMIT PERMIT#
DATE f VALUATION LOT TRACT
-7
' 23545.3
JOB SITE I
APN
ADDRESS 49-4is Ai A.onlatl�oon
658-340-M
OWNER
CONTRACTOR / DESIGNER / ENGINEER
XSLDEMOPMENTCORP ORATIOW
K; DEVELOPMDnCORPORATIO14
55-980 PGA Alii D
55.980 PGA. BLVD
LA CZ'CTIi A CA 92253
LA QUWA CA. 92253
(760)564.7166 CB110 4676.
USE OF PERMIT
S'W(3I3? Z?Al' MY ":'F�/= i=
SFD. OT:8 PX.R.NA.A D�RS:MIT DOES NOT INCLUDE 31-OCK WALLS OR
L
IC 1SSUAWOF:
1`0069W PIAN 014W FF2.1LEDUCTION FOR MLIUMPL E.
FI ME PLAN TYPE.
('USTOM CONSTRUCTION 1.680.00 St?
Is.fi�71M CO OF COMISI 'RUQ:`�1.Tf).l�i
1.10,872.WI�Z�J
PU T S£AD&4RY
CONSTRUCTION IZE 101-i300.4IR.000 3'48.00
PLAN CHECK FEE 191--000-x1:39-318 X158.79
MECHANICAL FEE 101-000-421-000 3130.:0
ELECTRICAL 1W 1€31-000-420-000 $99.80
f,
PLUMBINGF ?Y, 101-000.419.000
STRONCI MOTION FEE RES1D 101-000-241-000 $13.09
r._. -
A� DG FRE 101-000-42.1-000 $20,00
GRADING
i .
DEVELOP RIMPACT FEFY
KM: •
(w_�..
z,.r.Z ri
SUB-T(3 rAl, CONWfRUCTION AND PIJW CHL,70K
v P.1 S
'U&W PRE-PAIUFM
$0,00
NOW
RECEIPT
DATE
Y f
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
.
Underground Ducts
Forms & Footings
Slab Grade
_� ? of
C4
Ducts
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
1 —1.2Q
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
Neater 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
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)
L
F. Z t
V�
s &&( OF LA QUINTA '
gING & SAFETY DEPARTMENT
cf of �^ 51 lJ. 777-7012 -
INSPECTION REQUEST LINE
777-7153 i
9
KSL DESERT RESORT, INC'
Owner a r
Contractor ' KSLIAND II CORPORATION
r
000T!
Permit Number
POST .ON JOB IN- CONSPICUOUS. PLACE
INSPECTOR"MUST SIGN°ALL APPLICABLE SPACES
49 4°12 AVENIDA.OBREGON
JOB ADDRESS
SFD-LOT; 8 PLAN 4A PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
{DATE c • INSP.
TYPE OF'INSPECTION
MAIN GRE
GROUND
-PRE-GUI
DO NOT -1
CONCRE7'
JOISTS-&
DL ..-1T P
FIREPLAU
ROOF
BOND BE
BEEN SIGNED
:F --
w
COVER.NO WORK UNTIL ABOVE HAS BEEN SIGNED;
DRYWALL INTERIOR
EXTERIOR LATH 6
POOL PRE PLASTER
0(9(11 }FFNCE & GATE ^' -
n I �
FINAL'S
CAL ,
rLvmu
FINAL GAS TEST
H NG - A/C-
FIS.'
/C
FIS. ,sE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
rr
X
Certificateof Occupancy
City of La Quinta
Uild ndSaly D arr�ent
This Certificate issued pursuant'to the requirements of. Section .10.9 of the Uniform Bui/ding
CLritlty'1Ii of t�iE' rrC G.f.%ssualic , this %truLtl.r� �.^%us i!1 CC�Il1�}>'/rl��;r? with the various orC/inalices
of, the .City regulating bui%ding..construction ;or use..,For`:'the fo/%wing:
BUILDING ADDRESS:. 49.412 AVENIDA.OBREG.ON
Use jClassification':. SFD Bldg. FerminNo.: 0007-283
Occupancy Group: R3_ Type of Construction: VN Land Use Zone: TC
Owner o:f Building: KSL DEVELOPMENT CORP,
Building Official
Address: 55-920 PGA BLVD
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 3-22-01
POST IN A CONSPICUOUS PLACE