0007-287 (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
7,142f 3 B0')313
Date Signature of Contractor r
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
performs ce of the work for which this permit is issued.
( iave 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 ZUYCICH IRIS. CO. Policy No. WC 6$3396507
(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' compensa 4 provisions of Section 3700 of the Labor
Code, I s all f rthwith comply with�t , se prove its
Date: Applicant V 7R
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 applicatbn 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 1for insp iong oses. 'n ,
Signature (Owner/Agent) ,W Date uU
PERMIT" :
BUILDING PERMIT
DATE VALUATION LOT TRACT
$132,492.70 12 28.54.s .3
/ i t
,<
JOB SITS
APN i
ADDRESS 4452 52 AYEMDA Q W&GON
£# X40 01 "
OWNER
CONTRACTOR / DESIGNER / EN (NEER '.
XXL DF -VE •..OP)Nf CORPOWMOW
IC8L.'D1ZVKL0PNW..NT CORPORAT10M
55-920 PGA BLVD
55.920 I'GA BLVD ,.
LA C,22Z1XN'1A t:'AA 92253
s_
1..A QIfI NTA CA 92251
(/60)564-7166 CALF 4676t,
USE OF PERMIT
:»FD. i. T:I� PLAN:2B -P=MIT DOES NOT INCLUDE I3WCK: WALLS OR
POOL HANDICAP ACCESSIBLE AS PFR. APPR VED PLANS -
CUSTOM CO2NSTRUC'TION 1,674.00 sl?
PORCHIPATIO 15700 EF
£S'a'!i°}`lAAT1?'%i C'OfTr OF COiV MUC [TON
1:32,492.701 ,
PERhurrn SUMMARY
'
CONSTRUCTION ' t E 101-000-416-000 $755.00
PLAN CHECK FU 101-000-139-316 $696.75
I+ ECkI1NICALFFA 101.000^021-O00 $111109
Lr.LFXTRICAL FEE 101-000-420-000 $99.59
PLUMBD40FEE 101.000-419-000 $163,75
STRONG MOTION FEE - I4MID 101-000-241-000 $13.25
C#ILdiDIN.01:EE 101-000-42.3-,000 $20.06
DEVELOPER IMPACT FEE $1,90700
�a. ::i �•
FILL DEPOSIT 101-000-439.318 -$230.Q0
SUB -TOTAL CON.TrR1:IMON AND PY" C1EC.it
$3,766.34
iMIS PRE-1-1AmF=3
-WO.00
TOTAL P-111 ffrIMES DUEV 14OW
$3,59.CM
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —
Underground Ducts
Forms & Footings
Ducts
Slab Grade Qj '
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 ! Sri A�/
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
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:
Tt
CITY -0E --LA QUINTA
w (� (hol&g@; & SAFETYDEPARTMENT
cf F t� 777'7012 .
r.+
TION REQUEST LINE
fir'777-7,153
KSL DESERT RESORT, INC
Owner , ,^.;.>
(SL LAND II CORP&R ,TION x
Contractor• : p007=287
Permit Number
OST'
PON 0'B IN `C L ONSPIC000S'.PLACE
INSPECT. R -MUST SIGN ALAPPLICABLE SPACES
49-452 AVE NIDA,OBREGON
JOB ADDRESS
SFD- LOT 12 PLAN 2B -PERMIT DOES NOT ,
INCLUDE"BLOCK WALL OR POOL HANDICAP
ACCESSIBLE PER APPROVED PLANS.ONLY
DATE INSP.
TYPE OF INSPECTION
FOUNDATION &.SETBACK
FOOTING STEEL
MAIN.GROUND-SYSTEM
GROUND PLUMBING
PRE -GUN TE ;.
DO NOT POUR-CONCF(tTE UNTIL AL -CA VE tHAS BEEN, SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
5L. JT POUR CONCRETE UNTIL ALL ABOVE HAS BEENSIGNED
ROUGH, ELECTRIC
ROUGH -PLUMBING
ROUGH GAS "& GAS TEST -
HEATING & VENT.- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO` )NRAP'• '
GROUT' O 4' O B'
FRAMING
INSULATION
PRE -ROOF
CUVER.NO WORK UNTIL.ABOVEHAS EN SIGNED
LL,:INTERIOR3
EXTERIOR LATH
x
ppOL PRE PLASTER,
L ENCE 8 GATE
FWER'SEPTIC TANK'
ABOVE NON UTILITIES OR, OCCUPY BUILDING'
DING' O
Certificate of. Occupancy
City.bf La' Quinta
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,.
certifying that,. at the time -of issuance, this structure was i compliance with the various ordinances
of the" -ity'regcilating bah Ing construcfion or use For' the fo/%wing:
BUILDING ADDRESS 49=452 AVEN.IDA;`OBR:EGON
i Use Classification: SOD. Bldg-. Permit No..:. . 0007-287
,.
Occupancy Group: R3.. Type of -Construction: VN Land Use Zone:. : 'TC
Owner -'of. Building: ..KSL�DEVELOPMENT CORP.
Building Official
Address:
55=920 PGA BLVD.
City:
LA QUINTA CA 92253
By:
KIRK_ KIRKLAND
Date:
3-22-01
POST INA CONSPICUOUS PLACE