0007-281 (SFD)} .r 7 71
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
73428I3 FL f31f2(
Date -7Signature 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 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
perform
.,apce 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 aURICH R4& CO. Policy No. WG 633896507
(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, Isgha�lll foQrthwith comply with ° e prVolions.
Is_�
Date: ! " "+ Applicant_ t
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, indemnity
& 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 authorizterepresentatives of this City to enter upon
the above-mentioned prop- or ns ction urposes.
zr)Signature (Owner/Agent) _ Dated
PERMIT#
' BUILDING
-PERMIT- t r .
DATE VALUATION LOT t �
TRACT1:
a ��
; t .?i 6
7'i $13- .^25454;&",5.70
JOB SITE /
APN ' s
ADDRESS 49^4:20 A MgWA OBIZ-V0014
OWNER
CONTRACTOR/DESIGNER/EN INEER ,..
:KS.L. J)EVFL0PMM4T CORPORP.'I`I011l
X& D:EVO. OPMEk r CORPORADDR
55-920PGA:W,VD
55.920POABLVD
LA QUINTA CA 92253
LA QUINTA CA 92253.' ,
(760):I . -7166 CBJJV 1676,'
4
USE OF PERMITU4 ff,
♦XtLd \J.• R, 1'Cilrt L rst •a J
' -� ,.
SM LOT -6 PLP.'N:3e PERMIT DOES NOT 04CLUDE BLOCK WALL 3 OR a
PQL9I,73' PL.A14 CHECK PER REDUCTION MR I'6!U1.3IPLE ISSUANCE OF
SAME PLAN TVP&
CUSTOM C014STRUCTION 2,443,00 SF
PORC'HIP.ATIO 320.00 SF
RGID"ERE OOH' OF C0.NS'YRY7t.7n0X
194,x.70
PMAM FEE tIi MAURY
CONOTRUCTION "Ll 101-000.416.000 $9%.00
. .
PIAN CHECK IPdE 101-000-439-315
MECHANICAL FELE 101-000-421-000 $136.00
r.
Le=? TRICAI, FEE 101-000-120-000 $126.51
;
PLUMBING FEE 101.000-419-000 $201.09
STRONCI MOTION PFE 4 RMI ID 101-000-241-000
ifJ
O A.DI G FRE 101-000.423.000 $20.00
DEbI LOPE•F IMPACT FEE $1,907.00
t..t
a4
4:J_;
SUB-1'O`l'Al, CONS'DRUM'OW.F',ND PLAN CWrX
UAW.%
IMS PRE -PAM Tse
X0.00
'1(YrAL, PERMIT I " DUE NOW
4
MOAX
RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs-
Underground Ducts
Forms & Footings _ j _
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing c -
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O. i
Fans & Controls
Party Wall Insulation'
Condensate Lines
Party Wall Firewall ;
Exterior Lath i
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
i
Equipment Location
1
Underground Electric
i I I
Underground PI . 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 I
O.K. for Finish Plaster
Sewer Lateral I
Pool Cover
Sewer Connection j
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
I
Final f
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole'
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures i
Main Service i
Sub Panels
Exterior Receptacles
G.F.I. j
Smoke Detectors
Temp. Use of Power
i
Final
Utility Notice (Perm)
Certificate of Occupancy a�
o�
City of La Quinta
B �'u ding and Safety,,.De a-tme ,t
p_
:T/ is .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 regu/acting bui/ !i construction' or use. For the. fo/%wing: ✓
BUILDIN..G ADD-RESS: ' 49-420 AVENIDA OBREGO'N
Use Classification: S.FD. Bldg., Permit, No.:. 0007-281-
Occupancy Group: R3 Type of Construction: VN Land"Use Zone: TC
Owner of Building: KSL DEVELOPMENT CORP Address: 55-920 PGA. BLVD
City: LA QUINTA CA 92253
v By: KIRK KIRKLAND
Building Official
Date: 3-15-01
POST IN A CONSPICUOUS PLACE
LY-5
CIT Y OF LA QUINT
1G & 5AFETY•DEPARTMENT
OF. • 777-7.012
IN,$R.FjGTION REQUEST LINE
r 777-7153
KSL DESERT RESORT,INC
Owner
Contractor . KSL LA N.D,'II CORPORATION
Permit Number
0007-28'1
POST ON JOBAN,,CONSPIC000S'PLACE
;INSPECTOR MUST.,SIGN "ALL •APP.LICABLE SPACES
49-420 AVENIDA OBREGON'
JOB ADDRESS
SFD-•LOT''6 PLAN 3 -PERMIT DOES NOT INCLUDE
BLOCK WALL ORPOOL
TYPE OF INSPECTION DATE
FOUNDATION.& SETBACK
FOOTING STEEL
MAIN GROUND. SYSTEM
GROUND PLUMBING, C_ w /
PRE=GUNITE .
DO NOT POUR CON CRETE;UNTLL ALL ABOVE MASN.
;BEESIGNED
CONCRETE SLAB-
JOISTS
ELECTRICA", ROUND -.WORK:
DL .JTPOIJWCONCR . EUNTILALLABOVE.HAS.BEEN.SIGNED'
ROUGH ELECTRIC`;,.
ROUGH,PLUMBING .
ROUGH GAS & GAS TEST v
HEATING & VENT -'A/C
FIREPLACE
,ROOF C>i`
BOND BEAM
O.K. TO'•:WRAP f.C-)
GROUT '❑ 4' ❑ V
FRAMING _ Q
INSULATION
PRE -ROOF
COVE R,N'U.WORK:UNTILAB OVE HAS.;BEENYSI,GNED_ .
DRYWALL INTERIOR.,
EXTERIOR LATH. 7'f '
POOL 1PRE PLASTER.
qENCE & GATE`_
StWEA SEPTIC TANK;
.,FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST • '' — ' .0
H NG - A(C
HL_. ENUMBERS
JOB COMPLETED'
TEMP POWER
ABOVE APPROVALS DO NOT,INCLUDE RIGHT TO.-.
TURN ON UTILITIES OR OCCUPY BUILDING