0007-290 (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 # ry Lic. Class Exp. Date y
!
Date jTcr-D 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 andwill maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
perfor ce 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 7UR1CH INS. CO, Policy No. WC 633391650''7
(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 tq the workers' compensation provisions of Section 3700 of the Labor
Codeall rthwith comply withI=—
.Date: r ApplicantP0. h
) A=
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 propfor inspection u •os s.
Signature (Owner/Agent) �' — Date—,
BUILDING PERMIT PERMIT# '
DATE/ VALUATION LOT Q�1T� TRACT ,
r- UJ3„'$41.1i1 1� 28545-3
JOB SITE
APN
ADDRESS 4.9-442 AVIE.MA OB E' Mli
658-340 CAIS 4
OWNER
CONTRACTOR / DESIGNER / EN &NEER
KOL DlZV IAl44014'r CORPOIRAMO N
XWL ] EV]9.GI'1lv1EN i CORPOFt:ATZC` N
55.930 PGA BLVD
55.920 PGABLV.D
LA QLlU Thi CA 92253
LA QUINTA CA 9225:3
(760)464.7166 0BL# 4676
USE OF PERMIT _Dv 1 / 5
SM. L.OT:I S PLAN: PERMIT .DOS 'NOT INCL UDE BLOCK 'WALLS OR
POOL
CUSTOM CONSTRUCTION 934,00 UP
PORCHMATIO 345.00 SF
CIARACIUCARPORT ( A324,00
ES711AUM CoS'1'Ora CONS UCnon
99,341.10
YdIVi�T �lJi�.u.YJJML E
CONSTRUCTION FJU 101.00.0.41$-000 $639.50
PLAN CHECK FEE 101-000.439_318 $535.37
MECHANICAL FEE 101.000.421-000
ELECTRICAL FELP 101-000-420-000 $97,44
PLUMBMG M 1011006-419.000 $136.00
STRO140 MOTION IVEE N R 91D 101-000-241-000 $9.93
GRADIN6 FRE 101.000-423.000 $20.00
DEVELOP211 IMPACT IEEE $1,907.00
`` Y
F99 DEPOSIT 101-000.439-318 -MUD
iii� h.... _
S- UB- CQld3'fRi1CUIri AND PLA111 CFC`T:,�24.I
iESD PRE -PAW FEES
1-4250.00
'!'OT's PMAOT FK0 DUE NOW
Fi?4:x"9
RECEIPT
BY �/
DATE FINALED
INSPECTOR
JDATE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_ b
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
-
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
f
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING. APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
U w Y OF•LA GIUINTA
" BUILD��G&,SAFETY DEPARTMENT
,777-701.2
tb$CTION REbUEST LINE
777-7153
j
= KSL DESERT RESORT; INC
Owner
RATION
ontractor
KSL LAND I1 CORPO
C's 0007-290:.
PerrAt'Number
POST °ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN",ALL APPLICABLE SPACES.
49-442: AVENIDA OBREGON
JOB ADDRESS
SFD-LOT 15 PLAN 1 PERMIT DOES NOT
INCLUDE BLOCK WALL#OR POOL
' TYPE OF INSPECTION,
DATE INSP..
ELECTRICAL GROUND-
POUR CONCI
'�-ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS,B GAS TEI.
HEATING &,VENT - A/C
FIREPLACE"
ROOF
BOND.BEAM
O.K. T0fWRAP
'JOB O
TEMP PO EW
ABOVE APPROVALS DO NOT INCLUDE ,RIGHT TO
TURN ON"UTILITIES OR'OCCUPY BUILDING
Vi'i 1 y.
®I
Certificate of Occupancy
City of La Quinta
�n and Safe
n
Budd g:v Ot of
TtiisCur issue&Oursuatt to "the requirements
1-69
of .tile Unifd Buil
qing Code,
jin-1 ce various' ordinahces
was�in.coT#1 -,with. t
certifying e.. -,time ofissuance"', this,structdre�,
of tlie..ci6 regulaihig building c o""struc dan, - or, us' e.'Foir'" the fdllb vvhng:'
BUILDING -ADDRESS: 49,-442 AVE.NIDA-_0.BREQQN
Use Classification: Bldg. Permit No.: 01007-290
..... ... .... ..
'-Occupancy Group: R3 Typp,of..C6nstruction: VN Lan.d Use 2666: "TC
77
Owner of Building:' KSL DEVELOPMENT 7CORP Address: 55-920 PGA BLVD
City: LA QUINTA CA 92253
By: KIRKXIRKLAND,}
Date: 4-9=01
c
Building Official
POST IN A CONSPICUOUS PLACE
III