0007-285 (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
734283 B 03/31.2(
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
performance 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:
Career UI'.JCII INS. (:0. Policy No. VIC 63384650
(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 with those provisions.
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 property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT"
DATE % % VALUATION LOT ` TRACT
$1.32 26545.3
92. i0 10
7 / / / .%;19
JOB SITE
APN
ADDRESS 49-460 AVFJ A 0D1,;W(3'0H
659-'34U4)7.0
OWNER
CONTRACTOR / DESIGNER / EN (NEER
ICSL I EVrI1..0PNfENT CORPORA .014
.E0L1FVFJ,0P1%034T CORPORA.CION
55-920 PCrALLVD
55-920 PGABI[ND
LA QLTMefA CA. 92253
LA QIHNTA CA 92253
(760)564•? 166 C!PU 4676
USE OF PERMIT
UNGH-BIZAIMMY -HF-
SPD. LOTA0 PI..AN:V.- PER14taIT DOES NOT INCLUDE BLOCK WALLS OR
POO1.75% PIAN CH CK FEE REDUCTION FOR MULTIPLE ISSUANCE ON
J,t1isAE PLAN TYPE.
CUSTOM CONSTRUCTION 1,6700 OF
PORCH/PATIO 157.00 SP'
HS11T."IX0 COST 01W CONISTRVC111flow
3.32,492.70
FEPJw '9[' 0470 suhedA Y
CONSTRUCTION PEE 101-000.418-000 S?59.00
PLAN CHWIK PEE 101-000-439-318 $158.35
NECHN141C.AL FEE 101.000-421.000 1111.00
IFA.ECTR1CA L la'EE 101-000-120-000 $99.59
I
PLUMBI1NO IEE i 01.OW4.19-000 2163.7
-Y
STRONG EMOTION FEE - RESID 101-000-241-000 $19.25
>w
GILADINOFEE 101.000-423.000 $20,00
'I.DEV LOP&I; IMPACT FFE $1907.00
a6Cu7 f. .. Rte'_•..
SUB -WY AL CONST.IMLPM70N AWL) FLAW Ci-IEM:'
$3,327.94
LL, 19.9 PR R-PIiia FERS
$0.00
'TOTA_IL PF'1�;T
S3. 22 7,94
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
.�
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-<5 0
Underground Ducts
Forms & Footings
Ducts
Slab Grade
UJ
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
1 _ +�
Compressor
Insulation
- _ Gq
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-Cj
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- ,-Qf
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out ?
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection i
_
-Ct- �-
Encapsulation
Gas Piping
Gas Test
Appliances
Final
FinalUtility Notice (Gas); "
ELECTRICAL APPROVALS
Temp. Power Pole e
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)- . D<
COMMENTS:
CITY -Of LA QUINTA
cF"'oFrHF• '�B�U�1�t 1G &..SAFETY DEPARTMENT
777-7012
INSPl�-CTION REQUEST LINE
777-71 S3
Owner KSL DESERT RESORT; INC
Contractor `KSL LAND II CORPORATION
Permit Nunitmr. 0007-285 .
P03T ON-J.OB IN• CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APP.LTOABLE SPACES
JOB ADDRESS' 49-460.AVENIDA'OBREGON
SFD LOT 10 PLAN 2A PERMIT DOES NOT
INCLUDE -BLOCK WALL,OR POOL
TYPE OF INSPECTION
ATION.& SSFTRark
ELECTRICAL
DO:,..pT'Mul
ROOF
BOND BEAM
O.K. TO WRAP,j "
GROUT O 4' ❑ g -
FRAMING
INSULATION
COVER NO WORK UNTIL .ABOW,HAS..BEEN SIGNED
DRYWALL' INTERIOR
EXTERIOR LATH i.
POOL' PRE PLASTER ,
POOL FENCE'B`.GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL O O ( L
PLUMBING.
FINAL GAS TEST d
H' vG - A/C
TEMP POWER"
'ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
'd m at m
Cerriticate of Occupancy
City o- f. La, Quints
B`uildng y' Department a,,,Saf',,ef
This to action* 109 of the Uniform Building Code,
Certificate. issued ursuant requirements Sc
Issua'-nic"e, this structure - 0 b"
of:' was in Yqpce viiithjft various ordinances
aerilfyi�� that; at t e liftTa".
of the City reI01ating-buildiig. construction= '
or use, Fdr. the - foloWing.
8U1L01NG.ADDRE1S.,S:. 49=460-. AVE-NIDA.-OMEGON.
Use Classification SFD, Bldg. Permit- No.: -'000I-285
'Occupancy Group:Type of Construction: VN 'Land Use Zone:' TC
-Owner" of Building: KSL,QEVELOPMENT CORP
Building Official
Address:-:
55-920 PGA BLVD
City:
LA QUINT4 CA 92125.6'.
By:
KIRK KIRKLAND
Date:
3=7011
POST. IN A CONSPICUOUS PLACE