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0007-294 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am lice e'nsed 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 -9 7T42 B 03 1! Date r DIK"4 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). O 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 perforpor1be of the work for which this permit is issued. ( I 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 2 UIUCH INS.CO Policy No. we 03396307 (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 a workers' compensation Drovisions of Section 3700 of the .Labor Code, I sh I,fortiw� comply with thos Date: I 1 } 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 uthorize representatives of this City to enter upon the above-mentioned grope for' s ction purp ses Signature. (Owner/Agent) Date 1) 0_9 BUILDING PERMIT PERMIT# DATE VALUATION LOT O'�i %-�,� TRACT % r.'; r_'j9�►,3'4I. £0 19 28513.3 JOB SITE APN ADDRESS 49458 AV£MA Olr3RECX)N 658-3404)19 OWNER CONTRACTOR / DESIGNER / EN 1NEER I8J DMLi?lyMF..1 T CORPORATION ICSL p L0P:iv11;'N,r eORF}t3TZA'i ow 35.920:PGABLVD 5.5-920 PGABLVD LA QC IXfA CA 92233 LA QUNTA CA 92233 (760)564.7166 012,1 4676 USE OF PERMIT _Dwei / , �� rr"�'i%uw'- 9W(3LE I+'A %A LY ,- �1 SM- LOV 9 PLAXI PZRM1T DORS NOT INdLUDE BLOCK WALLS OR POOL.75% PLAN CHECK FZRr REDUCTION FOR MULTIPLE ISSUANCE OF SAME PLAN T PF_ CUSTOM C© ISTRUCTION 9A.00 9TH POR.C".ATIO 245.00 SF GAR A.GFlCARPORT (SF) 23,324.00 FZrA ATF.D COST OIC` CONYMUCTION 99,341.10 PES r, = s1TAGY CONSTRUCTION F ►I E 101.000-415-400 1639.50 PLAN CHECK FEE 101-000.439-318 $133.84 MECHANICAL FRE 101-000.421-000 M.00 z. ELtr..CTRICALFEE 101-000-420-000 $97.49 PILIMBINO FLZE 101-0004419.000 4136,00 STRONO MOTION IEEE 4 RESID 101-000-241-000 $9.69 GRADIING FU. 101-000-421-000 $2000 DEVELOPER IMPACT FEE r C - SUB -TOTAL O''Ol\TWRUCTION AND PLAN CEikVX $3,022.76 LEM PRTE PAID P $0100 TO".tAL Plff MT "Y. —�+S DUE NOW RECEIPT DATE BY// ` DATE FINALED INSPECTOR *11 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - GU Underground Ducts Forms & Footings Ducts Slab Grade 06 11:� 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 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 I 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: 2, 20MTY OF;LA'QUINTA BUILDING & SAFETY DEPARTMENT F :....A .. ,. 77777012 INSPECTION REOUEST4LINE 777-7151 KSL DESERT RESORT, INC Owner ,. .KSL �LANDII CORPORATION;, Contractor 00;0:7=29.4 Permit Number ;rPOSTk,ON JOB ;IN CONSPIC000S PLACE " INSPECTOR MUST'SIGN,ALL',APPLICABLErSPACES,. 49-458 AVENIDA OBREGON�'- JOB,ADDRESS SFD-LOT .19 PLAN 1TERMIT DOES NOT INCLUDE BLOMWALL OR POOL: INSP. PRE-GUNI DO•NOTTP< CONCRETE JOISTS& G ELECT.RI.CA DO ..JT -P( ROUGH EL ROUGH PL .NED i95 FINALS ELECTRICAL OI H HUuSE NUMBERS JOB COMPLETED TEMP POWER "1' ABOVE APPROVALS.DO,.NOT INCLUDE RIGHT TO TURN ON UTILITIESOR-OCCUPY BUILDING , Certificate of Occupancy City- o.f La Quints Bu 'I and Safest: De artment OF This Certificate.issued.pursuarit to the requiremen#s of Section X09. of the Uniform Bui/ding Code, certifying ttiat, at the time. of issuance, . t/ is structure . was in.:comb lance with the various ordinances of the `City regu/a`ting building construction or use. For the fo/%wing: BUILDING-- ADDRESS: 49-458 AVENIDA•,OBREGON Use Classification: . SFD ` BI'dg. Permit _No.: 0001-294 . 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 By: • KIRK KIRKLAND d Date: 4-9-01 Building Official POST IN 'A 'CONSPICUOUS PLACE