0007-295 (SFD)LICENSED CONTRACTOR DECLARATION,
I,,�ereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 o the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
- ] Si a,�'
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
performa a 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 WS'. CO. Policy No. WC 693396507
(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 s all f rthwith comply wit ose ,r v Inns.
Date: � Applicant—
Warning:
nt— —`+ 1i`
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 propepV for ins ectipn proses.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT" •'
DATE VALUATION LOT TRACT
$99,2441.10 20 28545
JOB SITE %
APN
ADDRESS 49k- . A'1�..i`1'.IDA 0T=.Gv 31lT
OWNER
CONTRACTOR / DESIGNER / ENGINEER ,
F,3L DEVMOP1+ NT CORPORA:170N
ISL DEVELOPZvlF241T CORPORATION
55.920 PCYAPX. VD
55.920 PCYADL VD
Lik QlMiTA CA 92253
LA Q=TA CA 92253
('760)564.7166 C13LR 4 67 6
USE OF PERMIT
L?lE'V 6Td.�k:. Sl�dVil.l� 1 a rpt A�+i�
.
SFD- LOT:20 PLAN: I. PERMIT DOES NOT INCLUDE BLOCK WA -'GLS OR
POOL 75% PL 0 CHECK FBI RFDUC1'1ON FOR MULTIPLE ISSUANCE OF
SAME PLAN TYNE.
CUSTOM CONS'T'RUCTION 934.00 8F
PORCH/PATIO 245.00 yF
GARAWCARPORT (SF) 23,324,00
wI A77 m Ct7Kc ®I':+" caNS'iRvC"C, ov
f 41.7 U
]E'i!:RWr PER 13 UA0 RY
CONSTRUCTION FFH 101.000-418-000 T63v,3p
PLASM CHECK FEE 101-000-439-318 $133hi
MECHANICAL. FU 101-00"21-000 t,00
ELWTRICAL Fit:I? 101-000-,420-000 $97,40
PLUMBING PRE 101-000.419.000 $136.00
STRONO'NOTION FEE - RNID 101-000-241-t" 00 $9.93
<; "M,
GRADING 79B 101.000-423-000 $30,00•
�Y
DEVELOPER WPACT FEE $1,907.00
RM -TOTAL CON 119 MUCr10AT AND PLAW C'L3l K
$3.022. rd
LEM PRE -PAID MS
� ;£0.00
TOTAL FOOM MIS DVE NOW�M.76
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
e OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
t
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
Return Air
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
k 14
'n .r
t )} TY OF,
L__A�t QUINTA .
�" , fh4 . k .,
SAFETY DEPARTMENT
F T` 777-7012
r•
iNt' CTION:REOUEST LINE
r"777-7153
Owner KSL. DESERT"RESORT, INC
Contractor
KSL LANDS II CORPORATION
K", X0007; 295
Pefmic Umbers z ,
POST`ON JOB.'INkCQ ICU
00S PLACE
INSPECTOR MUSTSIGN.'ALLrAP,-PLICA'BLE SPACES
" 49 -462r -A IDA OBREGON
JOB ADDRESS„ `
SFD'-LOT 20 PLAN �1':PERMIT DOESfNOT
INCLUDE BLOCK WALL OR'POOL
TYPE OF INSPECTION'.
DATE ,INSP. r..
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND
GROUND
PRE-GUNI1
DO NOT -PO
.r,CONC—RETE •
JOISTS,& Gil
ELECTRICAI
D* T>PC
ROUGH' ELf
ROUGH PCI
ROUGH.GA
HEATIll
flRE—PLACE
ROOF
BOND BES
O.K. TO.VA
GROUT `C
FRAMING`
COV&,,NO. WORN
MW
rinAL
H
H E$NUMBERS
JOB, COMPLETED
TEMP POWER.'. ^..
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR'.00CUPY.BUILDING
Certificate of Occupancy
City of La Quinta
Building :and,Scafety Department 04o
This Certificate issued pursuant to the requirements of Sec 7.09 of the Uniform Bui/ding Coale,
certifying `fhat; at the time' of• issuance; this structure 1.as - n comp/lance with the various ordinances
of the Cify regu/afing building construction or. use: For the. fol%wing:
BUILDING ADDRESS: 49'-462'AVEM .OB,R.EGQN'
Use Classificat'i'on: SFD Bldg. Permit No.: 0007-295
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
Date: 4-19-01
Building Official
POST IN A CONSPICUOUS PLACE