0007-292 (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
34 3 B 1t2€
Date, 3 � 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
perfor nce 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 ZUPaCFI INS, CO. Policy No. WC 6$3896SO7
(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' compensatioq provisions of Section 3700 of the Labor
Code,.l.s I f�� ith comply with th'Q"Se pro --_-
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 propefor ins ec 'on ur Nes
Signature (Owner/Agent) ''/ Date4 )r'Y�
BUILDING PERMIT PERMIT"
DATE_ VALUATION LOT TRACT -
7/ t F'l 16'99,341.10 17 28545-3
JOB SITE
APN
ADDRESS 4s)_4so AVxmA 0B G®.IV
658.4*404)).7
OWNER
CONTRACTOR / DESIGNER / EN (NEER
KS1 DEVFJ,0PbAMYf CORPORATION
KOLDEVELOPWWCORPORA710H
55-9201PGABLVI)
55.920 PGAB1,.VD
LA QUINTA CA 92253
!A QtT.lA rA CA92253-
(iE0)564-71.66 CB1,0' 4 67 6
USE OF PERMIT
G7JJ.V V.La9.+d'ALY�1L1 Fad Fl C s
-.
SPT)- LOT:17 PL&N:I- PitUAIT DOM" NCYf INCLUDr BLOCK WALLS OR
POO[,75% PLAN CRECK FEE REDUCTION FOR MULTIPLE ISSUANCE OF
SAME PLAN TYPE,
CUSTOM CONSTRUCTION 934.00 SP
PORCHIPATIO 245.00 SI
GAR.AGEICAR.PORT (St) 23,324.00
Egr I'ED COWr 01t' COXYMUC'i-On
99,341.10
CONSTRUCTION NEE 101.600418.wo 1639.50
PLAN CHECK IE 101-•000-439-318 $133.94
MECHANICAL FEE 101-000.421.000 x'79.00
ELECTRICAL FEZ 101-000-420-000
r- }
P:LUMBINO FEE 101.000-419-000 $136.00
-Tv
STRONO MOTION FEE o R;:S1D 101-000-241-00 $9.93
GRADING FEE 101.000-423.000 $20,00
DEVELOPER IMPACT FEE $1,907.00
ww
MM-`TOTAI, CON9FRUG` ON AA3D PLAN CkiWX
$3;022.76
IMS PPL -PAM T
$0.00
TOTA?, Ph-RMr ".'1rS ME NOW
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
rZ
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings t •
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 . p
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)
!e
Certificate of Occupancy
City of -La Quinta
uiling andafety D
` `
..-Bd
ppartment
This Certificate issued pursuant to the requirements. of:Sec tion. X09 of_the Uniform Bui/din Code
certif .in that, at the time of issuance, is structure was in Pomp/lance With the various ord nances
Y g th
of the.City regu/sting-bui/ding construcdda-or use. Forth fo/%win
9
BUILDINGADDRESS 49-450 .AVENIDA OBREGO;N
Use Classification: SFD Bldg. Permit -N'o.: 0007492
Occupancy Group:R3 Type of Construction: VN Land Use Zone: TC
Owner -df'Building: KSL DEVELOPMENT CORP Address: 55 920;PGA BLVD:
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
7
Dater 4-17-01
Building Official
POST IN A CONSPICUOUS PLACE
16. ??&ftY OF tA QUINTA."
BUILIJING&'SAFETY DEPARTMENT
777-7012.
INSPECTION 'RE60EST.'LINE
-777-7153
KSL DESERT-RESPRT, INC
owner O"TION
KSUF AND IFCORP
Contractor
onti`
L.
Permit Number
POST ON-, 6131N CONSPICUOu PLACE
' .,
INSPECTOR'MUST SIGN -ALL SPACES
49-450 ENIDA OBREGON
JOB ADDRESS'_"
SFD-LOT 17 PLAN 4 PERMIT VuhS NOT
INCLUDE
-
IDE BLOCK WALL OR POOL
-INSP.
ATE
TYPE OF INSPECTION
I _eTION
_
_t;P0UR CONCF
ROUGHELECTRIC
ROUGH :PLWMBING
N�mmm�_
r-o"am
PLUM
'TIRALj
JOBCOMPLhlhul
T P�
:EMp-pOW�EFR
ABOVE APPROVALS 66 NOT INCLUDiE,RIGHTTO
OCCUPY BUILDING
6it4.bN UTILITIES Ti'A