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0007-274 (SFD)x,. LICENSED CONTRACTOR DECLARATION I h'er`eby 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 3 :J;1 2t Date 31 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 ,r �.F 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. (,),I 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 ZURICH ITIS, CO. Policy No. WC 68389630' (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' compensate provisions of Section 97,00 of the Labor Code, I sh II f hwith comply withtt o e p � "� ity Date: Applicant 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 pope , for'&npecti,?or oses. Signature (Owner/Agent)Date BUILDING PERMIT PERMIT# ' r- DATE—] VALUATION LOT W07-174 TRACT' // 1 �' C': $1:x,6 7'. / 26545.3 JOB SITE r APN ADDRESS 49-440 A.11MIDA 01DJ.Z ~C2'C N 6594 4G-Wl OWNER CONTRACTOR / DESIGNER / EN &NEER I: SL D.17VVIMO:FUENT CORPORATION Is.13L DEVELOPS, b T CORPORA71ON 55-920 PGABLVD 55.920 PGA BLVD I.A QVIIN'1A CA 92253 LA QMNrA CA 92253 (760,)564.7166 Cf" 4676 USE OF PERMIT 13 NGI.EFAA9MY ' " *E i c: . SFD- IADT:1 PLANAD.ALT. PMRMIT DOO NOT INCLUDE BLOCK WA A S OR POOL CUSTOM CONSTRUCTION 1,680.00 SP F'8=4X2XD CO3Tf 0ff''C0JNMuC*noN 13019 Wo ?L+'Ip Wr1' b7EE I h94 AiZY CONSTRUCTION PRI; 101-000-418-000 A70.00 PLAN. CHECK FEE 101-000-439-318 $635.15 MECHANICAL FEE 101.000-421-000 $130.30 JUXCTRICAL IFIX 101-000.4ib-000 099.8 PLUMBING Fi1;i? 101-000-419-000 $171.00 STRONG MOTION I - RESID 101-000-241-000 $13.09 101.000-423.000 $ ,110 ORADINO FZ 0 t.` g DEVELOPER IMPACT FEE $1,907.00 FEB DC, POSIT 101-000-439-316 42S0100 i is x SU B -TOTAL COW',iT'RIYC II03d AWD PI,A4+T C:f.3--P.� AC $3,724.54 7.=- PRE -PAID MJ 42-30.00 T'O'IL MiMT M5 DUE NOW S%47454 RECEIPT DATE B.Y!!, ' [L .J DATE FINALED INSPECTOR W INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR i BUILDING APPROVALS MECHANICAL APPROVALS Set Backs ^/ Underground Ducts Forms & Footings Ducts Slab Grade ©d Return Air Steel Combustion Air .Roof Deck - 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 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 GV 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 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 Utility Notice (Perm) .. 14b Certificate of Occupancy Q.uinta cit ®f La uln. o and SafetyDe'artm ent MoF This Certificate issued pursuant to' the requirements of.Section 709 of the. Uniform Bui/diri'g Code, certifying that, ., atl the time of,issuance. this structure was in comp/lance with the various ordinances of ttie Cit' �regu/ating building construction or use. For the following: BUILDING ADDRESS: -49-440 AVENIDA O.BREGON Use Classification: SFD. Bldg. Permit No.:,=0007-274 Occupancy Group: R3 Type of Construction: VN Land Use Zone: TC Owner of Building: KSL DEVELOPMENT CORP 44 Building Official W Address: 55-920 PGA -BLVD City: LA QUINTA CA 92253` .By: KIRK`KIRKLAND Date: 2-16-01 . POST IN A CONSPICUOUS PLACE r z TY OF LA QUINTA .'. `x:.70 BUILDING & SAFETY DE. PARTMENT �f Or n+�° ; . is 777-7012 CTIQ,N' REQUEST LINE 777-7153 KSL DESERT RESORT, INC o Owner -, KSL LAND II.,CORPORATION Contractor ,w !. 274. Permit Number POST ON JOB IN CONS AIP U'OUAB E`SP CES INSPECTOR MUST S.IGN.A 440 AVENIDA`OBREGON JOB ADDRESS SFD= LOT 1 PLAN AD,. ALT.' -PERMIT, DOES NOT INC LUDt .BLOCK WAtL.OR POOL TYPE OF INSPECTION DATE INSP. FOUNDATIONS SETBACK OOTIN -STEEL MAIN GROUND.SYSTEM 3ROUND,PLUMBING PRE-GUNITE ; DO NOT POUR CONCRETE�UNTIL'ALL ABOVE HAS BEEN SIGNED CONCRETE'SLAB JOISTS:& GIRDERS ELECTRICAL GROUND WORK DL JT POUR -CONCRETE UNTIL ALL ABOVE HAS BEEN:SIGNED ROUGH ELECTRIC. . ROUGH PLUMBING , ROUGH-GAS.8.GA5TEST - :1 - HEATING & VENT • A/C -FIREPLACE ROOF �? BOND BEAM O.K. TO`WRAP GROUT : O 4' ❑ 8' FRAMING INSULATION PRE -ROOF COVER NO:WORK UNTIL ABOVE HAS.BEEN SIGNED DRYWALL INTERIOR TANK FINALS ELECTRICAL r' P. Cil '111 PLUMBING FINAL' GAS:TEST - H' ,NG'='A/C H(,-dE NUMBERS ` JOB COMPLETED . TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR.000UPY BUILDING ..f ;. r 1