0007-280 (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 13,. 1343 v2(
Date % Signature of Contractor V
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
performa ce of the work for which this permit is issued.
( )ave 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 ZURICH INS. CO. Policy No. we 62380007
(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' compenstion provisions of Section 3700 of the Labor
Code, shy I f'rthwith comply with t ose p o I ionsi
Date: S Applicant 1/
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 p y f r'I s ection nwooses.
f
Signature (Owner/Agentj�� '- DateA r2)
BUILDING PERMIT PERMIT#
Otti%-
DATE._ VALUATION LOT TRACT
7 I� C..} 5132,492.70 5 28645•.3
JOB SITE '
APN
ADDRESS 49-424 .AVICMM , CD1`YW. 43,4.K
653-340-005
OWNER
CONTRACTOR/DESIGNER/EN INEER
XSL DEVE-LOPIYO, 9T CO.RPORA170H
K% DEV0_OP WT CORPORAf10N
55.920 PGABLVD
55.920:1 GA i3LVD
LA QU-JN- A CA 92253
LA. QIJINTA. CA 92253
(760)SCA-7166 G'F3 h 4676
USE OF PERMIT
51HOIXFAMILY ITW�=>,K'P-(
VD. LOT:5 PL9N.AA. PERMIT DOES NOT INCLUDE BLOCK WALLS OR
PO 0 LIM. % PLAN CHECK ", E R B D U C ► ION FFR MIIL.TIP1,K 188UANC P 0
9.A15£iE PLAN TYPE.
CUSTOM CONSTRUCTION 1,674.00 Sr
PORCWPATIO 15'%v0 SY
1t:s:E'J'li9A CFD COST OF COI! STRTJGnolq
132,492.1A)
fl'IMW7' Ti''J SUMMARY
CONSTRUCTION FEE 101-000-R 18.000� S.OD
PLAN C1dWX FEE 101-000-439-318 $15K35
, .
MECHANICAL FEE 101.000.421.000 $111.00
ELECTRICAL PW101-000-420.000 $99.59
PLUM11TJ=iiQFEE 101-000.419.000 $163.75
• n -.
STRONG MOTION YEE - RESID 101-000.241-000 $13.25
�v
t4IiA17JA10RET? 101.000.423-000 $20.00
.r.•1 r
DEVELOPER IMPACT F9E $1,097.00
y
R-tr'
MM-i'til.'I?L COlt fMUC'I°[(aY AND PT.T CBECK
$3,227.94
LESS P:1Z.&PAID FnS
$U00
TO IAL PEK"I 1 FFES DXTE 1liOW
$3,227.
RECEIPT
DATEY
1
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs ;�
Underground Ducts
Forms & Footings I
_
-
Ducts
Slab Grade
^�� fie/
Return Air
Steel 1
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap I
F.A.U.
Framing
Compressor
Insulation
Fireplace P.L. 1
Grills
Fireplace T.O. 1
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall !
Exterior Lath
,Z Z7 — cd
Drywall - Int. Lath
�Z
Final
Final i 7-0Y'
BLOCKWALL APPROVALS
Steel
POOLS -SPAS
Set Backs 1
Electric Bond
Footings
Main Drain
Bond Beam i
Approval to Cover
i
Equipment Location
i
Underground Electric
1
Underground Plbg. Test
Final 1
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
C.v
Heater Final
Water Piping ]
Plumbing Final
Plumbing Top Out }
Equipment Enclosure
Shower Pans {
O.K. for Finish Plaster
Sewer Lateral I4/
Sewer Connection '•
y v J( f�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances !
I
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole }
Underground Conduit i
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles }
G.F.I. i
Smoke Detectors 1
Temp. Use of Power I
1
Final ! A'
Utility Notice (Perm)
COMMENTS:
-
�IIITY OF. LA QUINTA
.
cFM �. owe '.1361CDING & SAFETY DEPARTMENT
of r+i 777-7012
�. _: d 91ikCTION REQUEST LINE
777-7153
Owner KSL DESERT RESORT, INC
Contractor KSL LAND II CORPORATION
Permit Number 0007=280
POST ON JO.B ,IN-CONSPICUOU;S PLACE
INSPECTOR -MUST SIGN.`ALL APPLICABLE SPACES
JOB ADDRESS 49-42'4 AVENIDA OBREGON
SFD- I.OT 5 PLAN 2A -PERMIT DOES NOT INCLUDE
BLOCK WALL OR?OUL
TYPE OF INSPECTION DATE INSP.
FOUNDATION:& SETBACK i.: ;_.
FOOTING STEEL
MAIN.GROUND SYSTEM
GROUND; PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HA_S BEEN IGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
Da../ST POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GASA GAS TEST
HEATING 8 VENT- A/C.
O.K. TO'.WRAP
GROUT 'O 4' O 8'
FRAMING
COVER NO: WORK, UNTIL ABOVE HAS BEEN SIGNED
�.
DRYWALL INTERIOR, y( yc_
:EXTERIOR'LATH
POOLPRE-.PLASTER
PO
.0 ENCE:&GATE_,
E EPTIC:TANK � .- c.✓
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIESs,,OR OCCUPY BUILDING
Certificate of Occupancy
City of La Quinta
:Buoldng and Safety .Depar=tmenf
This Certificate issued pursuant to the 'requirements of "Section 109 of the Uniform Bujlqing,-, Coidef,
certifying tt?at, at the time ,of issuance;;- this structure was in co mp#.4n
qe with thdvarious brdinances
of the City regulating buildingcon'siructioh or use. For the.following:
B U I DING: ADDRESS: 4!9-424,AVENIDA* OBREGON
,Use Classification: SFD.. 000.7-.280
Bldg, Permit�M.:.
Occupancy Group: R3 Type of Construction: VN Land Use Zone: TC
Owner of Building: - KSL-DEVELOPMENT CORP
9
Building Official
Address:
PQA'BLVD,-.
City:
LA QUINTA. CA 92256
By:
KIRK.KiRKLAND
Date:
3-07-01
POST IN A CONSPICUOUS PLACE