0007-291 (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
73428,3 D 03/31/2(
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
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 wits n ria, CO. Policy No. WC 633606507
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
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 property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
0007-20-1
DATE VALUATION LOT TRACT
-04.1.10 16 28545-3
..
JOB SITE
APN
ADDRESS 49-" Aw f1LDA OmmO.C7
c1�sv-'3 V 1 Sp
OWNER
CONTRACTOR / DESIGNER / EN (NEER
KUL DF_%7L 0PWYII*r CORPOR WN
XSL DIEVMO.PbaW. CORPOiRAnON
55-920 PGA13L VD
55.920 Y -GA BLVD
LA QUINTA CAA 92253
LA QY. RTrA CA 92253
(700)564.7166 CBT -4676
USE OF PERMIT n j /'�
w
L],dVOLE d'MS.YMi..b Oa =411T 1S ti..Cdl�X/lJl�_z
YAM
.
SPD- LOT:16 .PLAN1:1 PEMIT DOES NOT INCLUDE SL,OCK WALLS 011.
P00i,74% PIAN CHECK FEE REDUCTION FOR MULTIPIX ISSUANCK OF
SAME PU.N3 TSPS,
CUSTOM CONSTRUCTION 934.00 SF
PORCHIP.ATIO 245.00 SF
0ARAORWAR.PORT i; 21,:324.00
EgIn".17M COST OF COIie'rRua[20n
99 1.10
C0140'TRUCT10111EE 101-000-418»000 $tS39.5D
PLAN CHECK FEE 101-000-439-318 $133.94
WCHAN1CAL PER 101.0004421-000 $79.00
ELECTRICAL FEE 101-000-=120-000 $97.49
PLUMBING PEES 101.000.419-000 $126,00
r- >
STRONG MOTION KEEL - R.1SID 101-000-241-000 $9.93
w'
ORAYDINO F9F 101-000-42.3.000 $20.00
DEVELOPER IMPACT IEE $1,907.00
'
t.....i .r .i
9'U:B-T'01 AL CONST RLIM1011 AND !PLAN CMCX
16r,-022.76 .
IMS PRE -PAID P1T.
$0.00
TOTAL PIU? UT FM DUE NOW
K5,02-2.76
RECEIPT
DATE
J
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_Y_Jcr ^J
Underground Ducts
Forms & Footings
_a2c/
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
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
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:
t �
777.7153 v
ner KSI,DESERT RESORT, INC
Ow
Contractor < KSL LAND II CORPORATION x
Permit Number 0007 113
291,E
POST ON'JOB IN,,C0NSPIC000S PLACE,.
INSPECTORMUST SIGWALL APP.LICABLESP,ACES
49=446 AVENIDA OBREGON
JOB ADDRESS„ !� ,_. _ .
SMLOT'16 PLAN 1,,'P* IIT DOES NOT
INCLUDEBLOCK WA L OR POOL
V,
ABOVE AFFROVALS;DO NOT INCLUDE RIGHT. TO
TURN ON,UT�ILITIES OR OCCUPY.BUILDlNr,
Certificate of Occupancy
..-City of La QuIn'taM®r
Etifl-dipgpartment
ond Safe y DecF,koF,ti°
i
This . Certificate, issued pursuant to the requirements ,of Section 109. of the. Uniform— Bui/ding Code,
certifying 'that, at the time of issuance, this,..structure was in comp/iance ' with the various ordinances
of. the City, regulating bui/ding construction or use.. For the following:
BUILDING ADDRESS: - 49 446.AVENIDA' BRE'GON
Use Classification: SM Bldg: Permit No.: 0007-291
Occupancy Group: R3 Type of. Construction: VN Land Use Zone: ., TC
Owner of Building: KSL DEVELOPMENT CORP
.7
Building Official
Address::
55-920 PGA BLVD
City:
LA QUINTA CA,92253
By:
KIRK.KIRKLAND
Date:
4=12-01
POST IN A CONSPICUOUS PLACE