0007-282 (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
i $283 B ./.31/2(
Date Signature of Contractor
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 tie 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.
(r-),.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 ZuRicki 11491 CO. Policy No. WC 69306507
(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 w rkers' compensation provisions of Section 3700 of the Labor
Code, I sh I foo with comply with t e pr'o7 s o�i s.
Date: _ �� Applicant- x f
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 propl for inspection purposes.
Signature (Owner/Agent) gig 4 Date t12i
• f
BUILDING PERMIT PERM'T#
000 1-282
DATE VALUATION LOT TRACT
$112.,492.70 7 28345-s
7
JOB SITE
APN
ADDRESS .49 _41619.x/ 29 ®D (3Kj1';
Z1al(Y^W'P61 (1{i 7 -
OWNER
CONTRACTOR / DESIGNER / EN (NEER
L I)EVEWPNODU C(yp"RMION
XSL DEVh'L0P1vVDs°1 COP.POR-KnON'
55.920 PGABLVD
55.920 PGA33LVD
LA QLTO T.A, CA 92253
LA QUINTA CA 92253
Q60)564-7166 ML4 4676
USE OF PERMIT Ir
IRINaU rAM
SFD= LI7r3 PLAN 20- PERMIT DOES NOT INCLUDE 81.4101CK WALLS OR
POOL"75% PLAN C HRCK FLOC REDUCTION FOR MULTIPLE ISSUANCE CSP
SAME PLAN Tii'PK °
t.
CUSTOM COWSTRUCTION 1,674.00 SF
PORCH/PATIO 157.00 SP
71 iI1VI.." COr�'T Oir CONS'I`R1 a-rlos
132A92.70
P 2WT FEW N UhW&Ry
00149 RUCTION FRIT 101.000.418-000 $199.00
PLAN C:HECX YES 101-000-434-318 $159,33
MECHANICAL FIDE 101.000-421.000 $111.00
ELECTRICAL, FEE 101-000-420-000 $99.59
I .•>
PLi MBINQME 101.0700.419-000 $163.73
STRONG MOTION FEE - REBID 101-000-241-000 $15.25
F4 •t ,
GRA i&W PEE 101.000.423.000 %20.6A
L
DEVEWPZR IMPACT FEE $1,907.00
�i
iY J
SUB TOTAL. C099 TRUCTION AN'D PLAW C5WrK
$3,227.94
LESS PKE-T'ALD 14=9
$0.00
TOTAL PERWrNMES DZ?1s" I40W
0,217.94
RECEIPT
DATE BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPRQVALS
Set Backs I
Underground Ducts
Forms & Footings I
Ducts
Slab Grade I
Return Air
Steel ]
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing i
Compressor
Insulation l
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall i
Exterior Lath
Drywall - Int. Lath I — C2 / L
I
I
� .
]
Final
Final. I
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs }
Electric Bond
Footings i
Main Drain
Bond Beam !
Approval to Cover
I
Equipment Location
I
Underground Electric
i
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines i
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out I
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection I
Encapsulation
Gas Piping I
Gas Test
Appliances J
1
Final
!
Final {
Utility Notice (Gas))
ELECTRICAL APPROVALS
Temp. Power Pole;
Underground Conduit
Rough Wiring i
Low Voltage Wiring
Fixtures I
Main Service
Sub Panels {
Exterior Receptacles
G.F.I. I
Smoke Detectors I
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
.. CITY OF LA QUK- ,
. - G 16AIII➢" & SAFETY DEPARTMENT
777-7612
I'NSPVION REQUEST LINE
777-71`53
Owner KSL DESERT RESORT, INC
Contractor ' 'KSL: LANDII '.CORPORATION
r� .2 0007282..
Permit Number
POST ON JOB IN CONSPICUOUS PLACE �.
INSPECTOR (MUST SIGN ALL APPLICABLE SPACES w
49-416 AVENIDA OBREGON
JOB ADDRESS '
SFD- LOT 7 PLAN 2B =PERMIT DOES NOT INCLUDE
BLOCK'WALL OR. POOL
TYPE OF INSPECTION DATE : INSP.
FOUNDATION 8 SETBACK-
FOOTING, STEEL C� 1
MAIN GROUND SYSTEM
GROUND' PLUMBINGw. I
PRE-GUNITE,.
DO NOT, POUR CONCRETE UNTIL -ALL ABOVE HAS BEEKSIGNED
CONCRETE'SLAB"
JOISTS & GIRDERS'
ELECTRICAL GROUND WORK
DL JT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GASH GAS TEST �J 4
HEATING & VENT - A/C
FIREPLACE
ROOF.
BOND BEAM
O.K. TOIWRAP
GROUT O 4'• ,O 8'
FRAMING
INSULATION
PRE -ROOF'
COVERiNO WORK UNTIL ABOVE:HAS BEEN SIGNED'
DRYWALL INTERIOR { p f—
EX .ERIOR LATH �. , .. �:. `; ! " A
POOL PRE PLASTER
ENGE 8 GATE
E SEPTIC TANK
FINALS
FINACGAS TEST - L --U ( �•
_H: NG -.A/C
H%- _jE NUMBERS
JOB COMPLETED
TEMP POWER
-ABOVE. APPROVALS DO NOT+INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
Ceti of La, Quir►ta.
f- ily-�e�arfinen@
S' -I,dhig, andSa
C ertitica- te issued pursuant to the requir6ments of Section 109 of the Uniform Poi/ding. Code
51 tc, --c- .,was 11.1he various ordinances
ct, -th a t, a t tirie. of his. s Ll' in c, lat.7.c e wl t
of the, City regulating building construction or use. For the following:
BUILDING .ADDRESS:. 49-416. AVENIDA. ORREGON
Use Class,ificatibn: SFD Bldg. Permit No..: 0007-282
Occupancy. Group: 3
Type of Construction: VN Land Use Zone: TC
R,
Owner of Building:.. KSL" DEVELOPMENT CORP
Building Official
Address:
55-920 PGA, BLVD
City:
LA QUINTAL CA 92253
By:
KIRK KIRKLAND
Date:
3-22-01
POST IN A CONSPICUOUS PLACE