0007-286 (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
3i 8� B
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
perform 6e of the work for which this permit is issued.
Z
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:
Cartier ZURICH iR1S. CO Policy No. we 683890507
(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 1he workers' compensationZe
roves nsr f Sectio 00 o_ f the Labor
Code, I-srh IVo�tj�,w h comply with th¢ provi io min //iy/
Date: 11 UV Applicant t
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 properfq-f r ms ec, to ur se
17
Signature (Owner/Agent) �j�=�✓ Dat 1311W
BUILDING PERMIT PERMIT# -�
+
DATE.,- VALUATION LOT W07-2ft TRACT
$194,W 11 285
JOB SITE
APN
ADDRESS 49-441 J1itiPI;1mA 0mwow
4g O
OWNER
CONTRACTOR / DESIGNER / ENGINEER
II ,%_ , DEV1:,C.OPNW CORPORATION
I, 8.L DFFV1iLOIXP .NT CORPORATION
55.9 .0 PCNAB-LVD
55-4 20 PQAB1;VD
ISA. QUTL+1 fA CA 92253
I aA Q'f.7INTA CA 92233
(760)W-7166 CBW 4676•
USE OF PERMIT --D Wq j (, M
mCi•I.1: nmLyS�5l
SFD- L0T:1 I PLAA1:3> PERMIT MES NOT INCLUDE SLOC:K; FFrIALLa bR
POOL,75% PLAN CHECK FEE REDUCTION FOR MULTIPLE ISSUANCE OF
SAME KAN TYPE.
CUSTOM CONSTRUCTIO14 %443.00 SF
PORCHIPATIO 328.00 SF
IATED COST OF, C0X9r.t�iTC Jr1U.N
194, ,70
•� p� =-� y'y Y19'p6yM
1�" RAWM SdJSg7iV68•a�.iR
..
CONSTRUCTION ISE 101~000-418µ000 $972100
PLAN CHEC1C ZBE 101-000-439-318 X203.9?
MECRANICAL FEE 101-000.421.000 $156.00
LLIX RICALNEL 101-000.420-000 $123.31
PLUMBING TSB 1.01.000-419.000 $201,00
STRONG MOTION FEE • R.ESID 101-000-241-000 $19,46
CRAD1140 FEE 101,-000-423•,000 $20.0
0LV1 L0P1~_.1MPACT FEE $1,907.00
� e
SLTB-TEAT. CONSDI CgION AND PLAN 011M -O C
�;3,;�0►. .�
LESS PRE -PAID MS
1-40,00
110TAL PERWr 1Z+W-B DVE w(,W
&-3,M594
RECEIPT
DATE
I BY/ �,
DATE FINALED
INSPECTOR .
INSPECTION RECORD
r_ _
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
t
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
-
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out ;
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
a
4. .
s CITY OF LA QUINTA
OE{JVNSIG & SAFETY DEPARTMENT
F " 777-7012
a INSPECTION REQUEST LINE
" 777-7153
KSL, DESERT RESORT, INC
Owner. : r
Contractor KSL LAND II CORPORATION
} 0007-286 , ,.
Permit Number
POST ON �J.OB .IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN.ALL' APPLICABLE SPACES
49-456'O
AVENIDABREGON
JOB ADDRESS
4D --LOT 11 PLAN 3 PERMIT DOES NOT:.
INCLUDE BLOCK WALL OR POOL
TYPE OFINSP, QTION DATE `INSP.
FOUNDATION j SETBACK +I - 3d
--------------
FOOTING STEEL.
MAIN GRQUNp;$YSTEM
GROUND PLUMBING.' . . c%
PRE-GUNITE
DO NOTiPOUR' CONCRETE UNTIL ALL ABOV HAS BEEN` I ED
CONCRETE SLAB.: �lS
JOISTS & GIRDERS
ELECTRICAUGROUND,WORK_ j
DC...JT POUR?CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH'ELECTRIC
ROUGH, PLUMBING `
ROUGH GAS:S GAS TEST
HEATING &:V.ENT-A/C* a'•..;,s�
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT G"4' O 8'FRAMINO
INSULAN
Tj
a,
'0
PRE -ROOF •
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL -INTERIOR
EXTERIOR LATH
POOL PRE: PLASTER _ A4
PQQL FENCE•& GATE
RSEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST -
H �NG A/C
Pu.,SE NUMBERS
JOB COMPLETED
TEMP.POWER
ABOVE APPROVALS DO -NOT INCLUDE RIGHT TO
TURN ON.'IJTILITIES.DR OCCUPY BUILDING
%
■ ARE
City of L a Quints
wilding and Safe4y Department
This Certificate issued pursuant to :therequirements of Section 109.: of the `Uniform Building Cod'
certifying that, at the tirne...of issuance, this structure was in comp/lance with the various ordinanc
of the°City regulating bui/ding-.constructon or use: For,;the ,fo/%wing;
BUILDING ADDRESS: 49=456 AVfN;IDA'yOBR:EGON
Use Classification: - SFD Bldg. Permit No.: 0.007=286
Occupancy Group: R3 Type of Construction:, VN Land.;Use Zone: TC- -
Owner of Building:KSL DEVELOPMENT CORP Address: 55=920 PGA BLVD
City: LA QUINTA CA 92253
"ate By: KIRK KIRKLAND
Date: 3-22-01
Building Official
POST IN A CONSPICUOUS PLACE