0007-278 (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
34 83 � ��• -Q3 3 12(
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 ,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 of the work for which this permit is issued.
( ejThave 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. WC 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' compensatio pr Ions of Section 3700 of the Labor
Code hall forthwith comply with t o e r l to
Date: 1; r (AJ Applicant `y?E 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 prppa y for'nspectionp4oses.
Signature (Owner/Agent) Date1
BUILDING PERMIT PERMIT#
DATE_ O VALUATION LOT��� TRACT
r k S132,492.70 3 283RS•3
� 1
JOB SITE! I APN
ADDRESS 49.432 AVENIDA OBREGON 6W.-3-19--003
OWNER CONTRACTOR/DESIGNER/EN (NEER
XL DEVI+x.0P1vflWr CORPORAnON
55.920 PCA BLVD
LA Qtl)) I -A CA 92253
USE OF PERMIT
SINGLEFAMILY
XXL nEVELOP..MENT CORPORA110N.
55-920 PGA BLVD
LA QVJWTTA CA 922S3
(760)56417166 C:B1A 4676
SPTI. LOT:3 PL N:2I3> PERMIT DOM NOT INCLUDE BLOCK WAL-LAS OR
POOL15% PLAN CK1;CK FER REDUCTION FOR MULT.IPI.•R 1811WANCE OF
SAUZ PL." TYPE.
CUSTOM CONSTRUCTION 1,674,00 3F
PORCHIPATIO 157.00 SF
7 XMUT= C oyr OF C;ONYMUC-1110 ;`i
112d492.70
PK.lWI* Yn, sulu"RV
CONSTRUCTION 171E
101-000-4-15-000
S"1SS.00
PLAN CHECK PEI:
101-000439-318
$158.35
MECIA"IC AL FEE
101-000.421-000
$111.00
ELECTRICAL MIT.101-000-420-OW
$99.59
a ,,
PLUMBING FEE
101.000-419.000
$163,75
-
STRONG MOTION 17FXI - RNID
101-000-241-000
$13.23
t s `
'y ; •.
GRADING FEE
101.000-423.000
DEVELOPER IMPACT Fft±L°
$1,907.00
- s
si r
n` e
t ,'x
K)B-TOTAL CONSTRUMON AUD PLAN C'"i•UECIC $3,227.94
LESS PRE -PAM PTES $0.00
RECEIPT DATE BY^. % / DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
APPROVALS
DO
MECHANICAL APPROVALS
Underground Ducts
Forms & Footings
(516 �!i
Ducts
Slab Grade
_
–[— �. �j
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
�= 2 �(i
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
`U
Drywall - Int. Lath
Final
Final 2. •Z -o
BLOCKWALL APPROVALS
POOLS - SPAS
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
_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connections
_
Pool Cover
Encapsulation ,
Gas Piping
Gas Test
Appliances
Final
Final L �
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 �. •Q
Utility Notice (Perm)
COMMENTS:
a� •c •
s . —CITY Of LA QUINTNT
K SRIG & SAFETY DEPARTMENT
CFb OF 1'Ht'777-7012
J"TION :REQUEST LINE
777-7153,
KSL DESERT `RESORT, ;INC
Owner
Contractor KSL LAND IICORPORATION
0007-278
Permit' Numbbr
POST- ON •JOB.IWCONSPICVMS,.PLACE,
INSPECTOR_MUST SIGN.ALL APPL.ICABLE.SPACES
49-432'AVENIDA OBREGON
JOBADDRESSs �. '
SVD -:LOT 3 PLAN 2B -PERMIT DOES NOT INCLUDE
BLOCK WALL OR POOL
TYPE -OF INSPECTION DATE INSP:
FOUNDATION & SETBACK
FOOTING STEEL"'
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HA EN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
EL'ECTRICALGROUNDWORK
D6�AT POUR CONCRETE.,UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS;& GAS TEST - _c)
HEATING &.VENT : A/C.,
ROOF
BOND BEAM
O.K. TO WRAP
GROUT '0 4' O 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO. WORK.UNTIL ABOVE HAS BEEN`SIGNED•,
DRYWALL INTERIOR' C1
EXTERIOR LATH
POOL -PRE PLASTER
!.92L FENCE & GATE
.*WEIh SEPTIC TANK
FINALS . ,.
ELECTRICAL
PLUMBING
FINAL GAS. -TEST
H 'NG "'A/C
HC�csSE NUMBERS
JOB COMPLETED
TEMP POWER
�l,iei:c ni► Nt7T=1NGLUDE,AIGHT TO
Certificate -of -Occupa.nc*y
� .
Aff
Cot Of.LaQusnrta
B" d,i�1
&Safet-an-,y..D.- m ..t."..a, imf
gFti°o.>~ .
This Certificate ^issued pursuant to tMe i.eqaiiements of Section 09,bfthe
Unif6r. m,B
uilding-Oode,
certifying
that, at ihe-" time Q isuqpce, structure
was z7 cqmpliance with the various orwrian
ces
-of lhe'qity_ rogglq 'For t
dn� bufldiAa construcaoa',&-.u'�' the e following;
pU].L,D1N,.(j'AQDRESS:' GdN
497432.AYEN1_QA'0BR'E
Usd:.1plagsific'ation: SPD
Bldg. Permit No.:
0007-278
AI
Occupancy Group:.._ R3, Typpe'of Construction: VN Land Use Zone: Tit-
O'W''ner of Building: KSL DtVELOPMOENT. CORP Address:
92b PGA BLVD
City: Lk QUINTA CA 92256
By: KIRK KIRKLAND
Date: 2-23-b1
Building, Official
POST IN A CONSPICUOUS PLACE
Rim