0007-277 (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
734283
Dateil� Signature of Contracto( !�
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
perfor ance of the work for which this permit is issued.
('7Ilhave 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, 00, Policy No. IVC 68389607
(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` provis'ons of Sectio 3700 of the Labor
Code:" 11 f t rthwith comply with th{oqs«` n
Date: 11 t Applicant 3C lf' ��,111111
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 herpbriuthorize representatives of this City to enter upon
the above-mentioned pro rty oJnp1bCTT0.__
1z/)(5D
Signature (Owner/Agent) Date,
BUILDING PERMIT PERMIT#
DATEVALUATION LOT OW7-277 TRACT
I j G (J $1:4)18 i'2.0 2 208545-3
JOB SITE' APN
ADDRESS 49-4:'.€ A:VKIVI.DA OBRFQON '658 -34O -W2
OWNER
KOL 1)EVEL0PMM4T CORPORAnON
55-920 PGADLVD
L -.A QUINT! CA 92253
USE OF PERMIT
OTHOI.J:1'iti6h7.1..Y °�.3*4
CONTRACTOR / DESIGNER /
TSI. DiEVF.LUPII4 W CORPOR K110N'
55.920 PGA.:131WD
LA QU1R]'t'A CA 922 S 3
(760)5641;166 CBIX 4,676
S'FD- LOT:2 PLGANAA- PERMIT DOES NOT INCLUDE BLOCK: W.A LLS OR
POOI..75% PLAN CHECK FEE REDUCTION FOR MULTIPLE ISSUANCE OF
SAME: PLAN TYPE.
CUSTOM C014ST 3.UCTION 1,620,00 SF
E911MXr= COST Ole' CO1q tUCnON'
PE!Rhffr FM 617AIPAARY
CONSTRUCTION FEE
101.000-418-000
$740.00
PLAN CHECK PEX
101-000439--316
$158.79
MECHANICAL FEE
101.000.421-000
$130. $0
ELECTRICAL I?U
101-000420-000
$99.8n
PLUMBING FEE
101-000.419.000
$171.00
ST1td7NQ MOTION FEE • RE ;1:3
101-000-241-000
$13.09
GRADING FEF,:
101-000.42:3-000
820.60
DEVELOPER IMPACT FEE
$1,907.00
BUJt-1-YWPAL C099Y U 1 09.AND PIAW G"TtW"--
i.iM PRE -PAW FP
TUTA. PXRWr 1XIES D11:E NOW
RECEIPT I DATE / BYy �� DATE FINALED I INSPECTOR
13,018 nim
$3,248,3.8
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Ducts
Forms & Footings
_CWA3Underground
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
ii(y
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall- Int. Lath
Final
Final
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
Utility Notice (Perm) -
COMMENTS:
(Certificate of -Occupancy ,�.
City of La Quinta .5
Building andSafefiyDepartment �`Maf�°
This :Certificate issued pursuant to the requirements of Section TOO," "Me Uniform Bud/ding Code
certifying that, 'ate the. time of issuance, this structure was in comp/lance `with :fhe various or,
of the City regu/sting bui/ding construction, or use. For #he: fo/%wing: .
BUILDING ADDRESS. 49-436 AVENIDA OBREGONr
Use Classification: SFD `Bldg. Permit No.: 0007-277
Occupancy Group':, R3 Type of -Construction:' VN Land -.Use Zone: TC' .
Owner. of Building: KSL DEVELOPMENT CORP
Building Official
Address: ' .,55-920 PGA BLVD-
City: LA QUINTA CA 92253
By KIRK KIRKLAND
Date: 2-16-01
POST IN A CONSPICUOUS PLACE
.B
ING & SAFETY •DEPAOF RT.
B� 777=701,2.
CTION.REQUEST LINE
777-7153
KSL DESERT RESORT, jNc
Owner
Contractor. KSL LAND J CORPORATION .
.,0007-277 ;
Permit Number,
POST ON JOB?,S GNONS LLL AP uO AB ELSPAC.ES
INSPECTOR MUS.
49=436 NENIDA OBREG..ON.
JOB ADDRESS
SFD- LOT 2 PLAN 4A -PERMIT DOES NOT INCLUDE
BLOCK WALL OR•POOL
JOISTS &
ELECTRI,
Dl �T
INSP.
SIGNED
COVER NO,W,ORKUNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR `U
cYTFriI()R I ATH � . S- Gc.i �✓�_
L FENCE & GATE .
R'SEPTIC TANK ? C_ ! LSC
FINALS.
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON.UTILITIES OR OCCUPY BUILDING