0007-288 (SFD).,LICENSED CONTRACTOR DECLARATION' e. }
'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
ss �2i•
Date � ; I( U13 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 affirmlunder penalty of perjury one of the following declarations:
() I have and•wll maintain a certificate of consent to self -insure -for workers'
compensation„,as provided for by Section 3700 of the Labor Code, for the
perfor ante of the work for which this permit is issued.
(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 EUpjCN INS. CO Policy No. WC 63339$S97
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject t the workers' compen$ns of Sec on 3700 of the Labor
Code,I al of;hwith comply wition
Date: s v Applicant—ERJ
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 prope, for i sect on urp83es.
�K /sem m/ajSignature (Owner/Agent) Dat
' -BUILDING PERMIT PERMIT# I;_
DATE VALUATION LOT TRACT
__��.�IIU� $.��3,�45�.'iQ► 13
..2+tCS�5�3�-.
JOB SITEJf
APN :.'a},•'
ADDRESS 4,19-448 AVFIMA 0BIMO014
00-34041.3 .,
OWNER
CONTRACTOR / DESIGNER / EN (NEER
M, DFVla OR2e ENT CORPORA IO14
r,.
I{13L DEV'.EGOPMEWT C0"0RM7tDN'7
55-92OPCIABLVD
55.920PUABLVI)
LA QLTMA CA 92253
LA QUJNTA CA.. 92253 •.:.' ,
(760)364-7166 CBVP 4676
USE OF PERMIT , /�
SWOL E TAtd1]'.LY' .^A=x n'r�• /
SFD- L Yr:13i!'LAN;3 PERMIT DOES NOT MCLUDE BLOCK WALLS OR. .
P001.75% PLAN CHECK F&B REDUCTION FOR MULTIME ISSUANCE OF '
SABRE PLAN TYPIC
CUSTOM CONSTRUCTION %443.00 9TH
PORCH/PATIO 320.00 SF
E9rJMATRD COSH.' OF CONUMUCF'IOW
i9�1 .719
MWT ME M06WRY
CONSTRUCTION ME 101.000-418-000 a972,00
PLAN CHECK FEE 101-000-439-318 $203.97
,
MECHANICAL FEIN 101.000-421.000 $154.00
LL ECTWCAL FEE 101-000.420-000 $126.51
PLUMBING F'FE 101-000.419.000 $201,00
STRONG FEE - RESID 101-000-241-000 $19.46
GRADING FEET? 101-000-423.000 3200
DEV P.WPER IMPACT PY-2 $1,907.00
IIT$-'rOrt.A.L COWL-RUM'10M AND ,PLAN CFDXK
$3,605.94
1MS PRE -PAM 1730.9
$0, 00 - � y'
TOTAL PKf'tll rS DUE
RECEIPT
DATE
BY
�er
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs — od
Underground Ducts
Forms & Footings — —
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 8 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
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)
CITY OF LA QUINTA
& SAFETY DEPARTMENT
OF . 777,7012
INSPECTION
777R1053 EST LINE
KSL DESERT RESORT, INC
Owner
ORATION
KSL LAND II CORP
Contractor 0' - 7-288
Permit Number
POST ON,"JOB IN MONS A'P UO AB ELSPACES
INSPECTOR*MUST SIG
X49-448 AVENIDA OgREGON
JOB ADDRESS
SF;D-LOT 13 PLAN 3 PERMIT POOLriOT
INCLUDEBLOCK WALL OR
DATE
INSP.
...oc rw.mSPECTION
FOOTING;
ROOF
BOND BEAM
O.K. TO WRAF
GROUT 0 4'
FRAM I N_
ABOVEHT TO
URN ON UUTIL TIES OROOCCUPY BUILDING
Certificate of Occupancy
IV ,
City of La Qutnt�i
g��� ��,
Dpp
Th...,'.c- Certificate issued pursu-ant to the requirements of Se'ctibn- 109 of the UniformB"Widing.,dooe',
"F!?ce %,V'! various ordinances
is Lh:
oi'the 'City re W� dhg - bdilding
g construction.'or use. Tor the fbllb vving;
BUILDING. ADDRESS: 49-448 AVANIDA OBREGON
Use Classification: .SFQ Bldg.. Permit No.: 0007=288
Occupancy Group.:- R3.. Type of Construction: VN Land',USe TC
OW'ner of Buildi-ng: KSL DEVELOPMENT -CORP
Building Official
Address:.
i55-920 PGA BLVD
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
3-22-01
POST IN A CONSPICUOUS PLACE