0007-289 (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
704283 B e 3131/2(
Date Signature of Contractor --W
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.
( _2,1.have and will maintain workers' compensation insurance, as required by
Sec I�t-on 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 2URIC i I1*IS. CO, Policy No. WC 68'Q%S07
(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' compensatip provisions of Section 3700 of the Labor
Code, I sh I fort =ply with tho a pr v
Date: ! licant `
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subjectan 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 property for inspection purposes.
Signature (Owner/Agent) ( Dated
BUILDING PERMIT PERMIT#
DATEVALUATION fi )7 289
_V/ / : ; $1.42,492.;G LOT 14 TRACT 2k545-3*
JOB SITE F APN
ADDRESS 49- 4N"K , TDA ODIU0019 68-344-014
d�
OWNER CONTRACTOR / DESIGNER / EN (NEER
K3L0EV0,0PMDff CORPORAT1ON KS:(, DFVM.0P.NJC%_,NT C0R.I'►CJltA 100
55-920 PGABLVD 55.920 PGABLVD
7.A QUJ14TA CA 92253 L.A t' UIWI-A CA 92253
(760)564.7156 CISL# 46;6
USE OF PERMIT A¢'-D%a .....U44
5SFD- LOT:l4 PLAN:2tA- PkR.AIIT DOES NOT rNCLUYIE BLOCK wALLo OR
POOI,.9S% PLAN CliECY. FEE REDUCTION FOP. MULTIPLE? I98U.M4CR OF
SAME PLAN TYPE.
CUSTOM CONSTRUCTION 1,674.00 $It
PORCHIPATIO 157.00 SF
F9M1X11= COSIr OF CoNb_rR"LTCll+C n
PREM FEE Std, AD"RY
CONOTRUCMON IT, E 101-ODO.415.000 S'7SS.00
PLAN CHECK FRA 101-000-439-3113
MECHANICAL FEE 101-000.421.000 $111.00
F^ -• 'r
IILEC'l RJCAI, ME 101-000-420.000 $99,59
c
;r
PLUMRiNp FR_r 101.000.419.000
STRONO MOTION JW, — RF;SID 101-000-241-000 $1129-
DINfI FEF 101.000-423.OriO $0.00
IdE."1rKDPER. IMPACT FEF $1,907.00
tr.-r
SUB -TOTAL CCiAWR'C C'Y10N' A D PLAN f i-1 K
$3,227.44
12-213 PRE, -PAID FM
$0.00
TOTAL YNRI QT IMS DVri. NOW
V31227.94
RECEIPT DATE BY- ' J DATE FINALED_ INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�!
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
_
Combustion Air
Roof Deck
—
Exhaust Fans
OX to Wrap
F.A.U.
Framing
_
' .� _ 4��
Compressor —
Insulation
Fireplace P.L.
/�2��-' .
l
Vents
Grills
Fireplace T.Q.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z •, m . ,
Drywall - Int. Lath�Z_
FinalGL-
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
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 Connection
�
-/ " 5
Pool Cover
Encapsulation
Gas Piping
Gas Test"l
Appliances
Final
Final O(
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:
,,y„.1.
aO •
Y01A QUINTA
BUILDING &SAFETTY DEPARTMENT
OF'fNt•v `,..:�.. 777.-7012 .
INSPECTION:REOUEST LINE'
777-7153
KSL .DESERT RESORT, INC
Owner
Contractor KSL LAND II'CORPORATION
Permit Number
'0007 289
POST .ON J0B'.IN -CONSPICUOUS. PLACE .
INSPECTOR' MUST, SIGN ALL APPLICABLE SPACES
``'49=444 ¢VENIDA OBREGON
JOB ADDRESS
SFD-,LOT 14 -PLAN 2A PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK - G
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 ,
D%. JT POUR CONCRETE UNTIL ALL ABOVE=HAS BEEN•SIGNED
ROUGW LECTRIC ••
ROUGH PLUMBING
.ROUGH -GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF (2
BOND BEAM
O.K. TO.WRAP
GROUT..0 4' O 8'
FRAMING C 67 G�
INSULATION CPQ
PRE -ROOF•
COVER. NO�WORK. UNTIL ABOVE;HAS BEEN SIGNED:..
DRYWALL INTERIOR
EXTERIOR LATH
POOL,, RE PLASTER,
:POO 'FENCE &'GATE
(StWE SEPTIC TANK 77 T
FINALS
ELECTRICAL _� 5'�”
PLUMBING
FINAL GAS TEST
_H. NG -A/C- .
H` _jEANUMBERS'
J.OB.COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES 00 OCCUPY BUILDING
'v
Certificate of Occupancy'
City of La Quinta
Building and Safety Department..
This Ve*rtif7cateJssued pursuant to the..requirements' of Section. - 109
.Tquire of the (Jnitbrm�- Building Code,
cerqfyiqg. that, at the time of -issuance, 1his structure was' -in compliance with the varibus'ordinances
-of the City. th7g `h .
WNing.construction.,or. use. For the 10110 ,
re�# wing:
BUILDING ADDRESS:. 49-444 AVENI DA.-o8REGO-N
Use Classification: SFD.' Bldg. Permii No.: 0007-2189
ti "Occupan-6y. Group: R3 Type of Construction: VN Land "Use Zone:.. TC
Owner of KSL. DEVELOPMENT CORP,
Building Official
Address: 55-9:20* PGA BLVD
City: LA QU
,JNTA GA 92256
By: KIRK KI . RkLAND
Date: 2-26-01
POST IN A CONSPICUOUS PLACE
I®