0007-279 (SFD)r LICENSED CONTRACTOR DECLARATION
1 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
383 B r 03/.31 /2(
Date _7�) 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 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.
(.� 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:
Carver ZUpjCI.1 INS, CO9 Policy No. OIbC 45IUit6$iY%,
(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 ofSection 3700 of the Labor
Code, I s II, f rthwith comply with ih �e�rofyisio /► __
Date: I f 4, Applicant ? l/ ( / Y
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 herebra thorize representatives of this City to enter upon
the above-mentioned propei for 'n pection pwoses.
Signature (Owner/Agent) l Dat
B7 *1
BUILDING PERMIT PERMIT# -
DATE ,-_. VALUATION LOT OW7_2119 TRACT
$1.94,
4 2854544
JOB SITE
APN
ADDRESS 49428 A,1ENWA OEIR_T+.•OOK
6W340 -OM
OWNER
CONTRACTOR / DESIGNER / EN (NEER
KSL TDbVM ,OP1 dFNT CORPORAnO.N
K.SL l lk:Vl aiICIP1`AF r CORPORA1nOyi
55.920 PQA.DLVD
55.920 PGA33LVD
LAQUIW A CA 92253
LA``QLs'I66k1TA CA.��+pppp92�253g6
'
`�
(760)5 4 J 1 56 4.E7.1_ Y 467 W
USE OF PERMIT
SSD- LOTA PLAN:3 PERMIT 00JUS NOT INCLUDE BLOCK iA ALIZ OR
POC)L7$% PLAN CHECK FEF R.EDUCTI014 POR MULTIPLE ISSUANCE OF
SAME PLAN TYPE,
CUSTOM CONSTRUCTION 2,443.00 JF
PORCfVPATIO 320.00 SF
7?'ST A.TED COST OF C0.KMZV(7110X
194, .110
P1 TieA T' FM SLTAAQ.RY
CONSTRUCTION FEE 101-000-416.000 $992.00
PLAN CHECK In 101-000.459-3183 *101-97
MECHANICAL FEE 101-000-421-000 SIX00
ELWTRICAL P= 101-000-420-000
PLUMBING IkTz 101.000*419.000 $201.0.0
STRONG MOTION FEE ., RFMD 101-000-241 �90U
ORAD1110 FEE 101F000-423.000 $X00
"AJ
oa_
DEVELOPER IMPACT FEE $1,901.00
�..�•�. `::
s.> i
9, b- +-11G A.L. CONST UC° O14 AND PLAA1' C'fk3.h U.K
$3,605.94
FEES
.�+ppy�r�++pp� YY ••�� 77 �7T+.��i��}y�PRE-PAID
TOTAL. L. 11MMU d, n_ S Sl6�E NO T7
�ry �$0.�00
$3,6'4lc�ai+4
RECEIPT
DATE
BY t
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- (d A44k
Underground Ducts
Forms & Footings
- ®ICf
Ducts
Slab Grade
- Q/Q
Return Air
Steel
Combustion Air
Roof Deck
- -
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
_ _ Cti dl
Vents
Fireplace P.L.
/-�
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. LathG—
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
eater 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
O
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 �p
Utility Notice (Perm)
HEATING:& VENT -.A/C
FIREPLACE
ROOF
BOND BEAM'
O.K. TO WRAP
GROUT O 4' Cl 8'
FRAMING ..
INSULATION O�
PRE -ROOF.
covER, NO"VORK: UNTIL ABOVE HAS BEEN SIGNED
DRYWALL -INTERIOR ".
EXTERIOR LATH .-7 ' _ r
POOL PRE PLASTER
FENCE & GATE
RSEPTIC'TANK C�!.. cei
--------------
FINALS. 1
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY• BUILDING
.af
��Y OF LA QUINTA
`'B�t1IG
CFM OF 1t�E� & SAFETY DEPARTMENT
.777-7012
woitTION REQUEST LINE
7774153
l
Owner KSL DESERT RESORT,.' INC
Contractor ' .KSL LAND' II •CORPORATION
Permit Number 0007-279
POST ON JOB -IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL AP,PLICABLE SPACES
JOB ADDRESS '49-428 AVENIDA OB'REGON
SFD='LOT 4 PLAN 3 -PERMIT DOES NOT INCLUDE
BLOCK WALL OR POOL
TYPE OF IN'DATE INSP.
FOUNDATION 8 SETBACK '-=" (•r'
FOOTING.,STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB.
JOISTS &'GIRDERS
ELECTRICAL_,GROUND WORK
( i
DLA_. T POUR CONPA ETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH.ELECTRIC
ROUGH PLUMBING
ROUGH GAS.'8"GAS TEST
HEATING:& VENT -.A/C
FIREPLACE
ROOF
BOND BEAM'
O.K. TO WRAP
GROUT O 4' Cl 8'
FRAMING ..
INSULATION O�
PRE -ROOF.
covER, NO"VORK: UNTIL ABOVE HAS BEEN SIGNED
DRYWALL -INTERIOR ".
EXTERIOR LATH .-7 ' _ r
POOL PRE PLASTER
FENCE & GATE
RSEPTIC'TANK C�!.. cei
--------------
FINALS. 1
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY• BUILDING
.af
in
Certificate Of Occupancy
'm SnaDer t ment on _.,n :and Safety va
This Ceftificate issueff'porsuant to the requirements of Section 109 of the Uniform Bufldiiig Code;.
certifying. that, at.t the -time of issuance, this structu'le, was'In: compliance.. with the various ordinances
j of the City regulating, b q construction or use.For. the 16110yving:
BUILDING ADDRESS: 4.9-428, AVENIOA. QBREGO.N
use Classification: SFb Bldg. Permit No.: 0007-279
Occupancy Gro* up: R3 Type of Construction: VN Land Use Zone: ':RL.
Owner. of Building: KSL:DEVE.LOPMENT CORP
Ups
Building Official
Address:
55-920 :PGA BLVD
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
2-5-01
POST IN A CONSPICUOUS PLACE
T,