0007-293 (SFD)LICENSED CONTRACTOR DECLARATION
f 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`44283 3QY.i Q�/31,
Date t%
� '� Signature of Contractor
LQ
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.
( ave 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 ZURICH INS. CO: Policy No. WC 6.03996507
(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 P
with thQ� rovl�I ns'�
Date: Applicant V • 31 X
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 prop, for ins ection p4rposes.
AI),ro
Signature (Owner/Agent) Date 1
BUILDING PERMIT PERMIT"
'
DATE VALUATION LOT TRACT
7
JOB SITE7 t
APN
ADDRESS 49-'4M AW_A C}IdRI.G01q
6.5&340-1?28
OWNER
CONTRACTOR / DESIGNER / EN (NEER
M DEVEWPMrLWf COR.PO fialOM
10L DI::�'1'.OP1vfb 1 U CORPORA1iON
55.920 PGA BLVD
55-920 POA LAPD
LA QZJUTA CA 92253
I A QUWrA CA 92253
(760)564.7166 GIZI t 4676
USE OF PERMIT
,1'D' JQ-L U N '
SFD- LOT:18 PLAN:1 PERMIT DOES'10OT rNCLUDE 8LOCX WALLS OR
POOL,` 5% PLkN alFCK FER R DUCTION FOR MUL` iPUE ISSUA.NC t OF
SAMP, PLAN TYPZ
CUSTOM CONSTRUCTION 934.00 SF
PORC:HfPATIO 845,00 SF
OARAGFJCARPOIIT (4P) 2,1324.00
E.%IJMATW COST 01 C01gM1rYC Off
99,4mo
PERl4 T M Whg"RY
rM
CONSTRUCTION FEE 101.000.418-000 Sti3p.Sfl
�� 3 2-,`•.
PLAN CHECK FEE 101-000.439-318
MECHANICAL. FTSE 101-000.421.000 x'19.00
,
ELI.i rR1CA11 FEE 101-000-420-000 $97.49
PLiIMBINO FEE 101.000-419.000 $136.00
-
STRCPAIOMOTION ME > XES)D 101-000-241-000
CR2A.D.INO FELE 101.-000.423.000 $20,011
DEVELOPER IMPACT FER $1,9(Y7.00
"f� 'tet
S'LIB-TOTAL C0)48 R1 C7'I'0M AM PI.A.W ClMCK
$3,022.76
LE951 PRE -PAID ..FFM
$0.00
TOTAL. P:N" 'r MES WEE) NOW
RECEIPT
DATE
BY~.`
DATE FINALED
INSPECTOR
k
:j
r INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 3 (:?-)
Underground Ducts
_
Forms & Footings
Ducts
Slab Grade _7i (�
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
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)
200JTY OFA LA
BOILDING,�,,..SAF,ETY-PEPARTMENT
oF.a _
77,7-701,2
INSPECT'ION'-REQUEST . EQUEST LINE
x77.7=7153
nerKSL'DESE.RT,*RES0RT, INC'
Ow
`W
Contractor KSL LAND li6N.
0007,20wl
PermiflSlumber Ni4, v
POST -ON JO,B IN-(,CONSPlCUO.US'PL!ACE, h.
I NS PECTOR MUST S.l G W'AULPPL ICAB LE�S PACES
454,AVE A00131tte.
JOB ADDRESS 40�
ON
SFD=LOT _118:TLAN,1,-?ERMM POES-NOT,..'.!
INCLUDE BLOCKWAL R POOL
TYRE OF I lbflON DATE' INSP.
_VSPE
j
c:
FOUNDATION ',& SETBACK "
FOOTING.STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING;.
PRE GUNITE
.00 NOT001.114 CONCRETE UNTIL�ALL ABOVE,,HAS BEEN SIGNED
CONCRETE SLAB:,
lil14.
.0�
IJOISTS&GIRDERS
ELECTRICAL GROUND WORK
676�T POUR`.,CONCRETE-.UNTIL A WABOVEf,`14AS_QEEN.SIGNtD
ROUGH ELECTRIC
ROUGH.`P.LUMBING
ROUGH,PAS�'& GAS TEST
HEATING &VENT - NC
-
FIREPLACE.
ROOF
BOND BEAM
OrX. TO,WRAP —
.J5FlOUT 0 4' 0: 8'
,
FRAMING
...INSULATION,,:
•
POOL FENCE AGATE`
SEWER'S
FINALS'
ELECTRICAL 7..','T''
�Cl 4
PLUMBING,'
FINAL GAS.TE
H N - A/
H *E NUMBERS' 74
JQV COMPLETED
TEMP POWER
-ABO%ilEA
, PPR&AL S- DO NOTI'NpLubtRiGH To
TURN I.- I T
ON UTILITIES OR '66ILDING -
OCrU.Py
Certificate of Occupancy
II r�agy,�gLa Quinta
Department
Bualding
and -d -S,',.afetY-..
ifo HMO
rm Bivi -Code,
t to the'.. requirenjehts''of, Section 1.09..6f .the Un
This Certifica,te.issued pursuant
vvas. in co*rl e with the vdrious_ ordinances
this stnictur-c
1Z
b i;i�&�g struc jon.,con use. For1he following:,
of the City. regulating ,.ok
BUILDING ADDRESS: -49-454 AVEMDA'08REGON
Bldg. Perr6it'-'No.- 0007-293
'SFD
Use Classification:
Land Occupancy Group: R3 Type of Construction, VN' Lan Use Zone: TC
Owner of Building: KSL DEVELOPMENT CORP
Building Official
Address: 55-920,TIGA. BLVD
City:. LA QPIN.Tk CA. M53
By: KIRK KIRKLAND
Date: 4-2-01
POST IN A CONSPICUOUS PLACE