0007-296 (SFD)LICENSED CONTRACTOR DECLARATION
I1hereby 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
B;/3112(
Date } �h 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 Sianature 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
performanc f'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 .URICH IW& CO, Policy No. WC 683396SO7
(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' compensatio rovisions of Section 3700 of the Labor
Code, s II f rthwith comply with tho proVi ii ,
Date: (f + Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prop for in ectign pur oses.
Signature (Owner/Agent) -�'- I _ Date - hdw
BUILDING PERMIT PERMIT"
tA07-19
DATE VALUATION LOT
xl TRACT
JOB SITE
APN
ADDRESS 49,%4 A m amoow
-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
yySL DVL.yY6Lp rolRTRA fOx
49L JE%ZrORN"r 4ORPORAn w
55920 PGA.BLVD
55.92;0 P(3A,BLVD
LAQI DI-fA CA 92253
LAQUINTA CA 92253
(760)564•1166 C -BL* 4676
USE PERMIT
J
DOFF
�y ��p �r--
M O E l`AIA L 1 a y'YMiVI
-
SFD- LOT -21 PLANA. PEWIT DOES NOT INCLUDE fJLOICK WALLS OR
POOL.75% PIAN CHFX.Y, IFU, R&DUCTION FOR MULTI 1PIX ISSUANCE Ole
SAME PLAN TYPE.
CUSTOM CONSITRUCT1OR 934.00 SF
PORCH/PATIO 245.00 SF
OARAt11"s!C„ARPORT (y 234324.00
ES71MA°}t!) COQ' OIC' C0PdVrRT7CTT01q
99,342.10
PFMWr FKF SL*A3.VYA%X
CONSTRUCTION FEE 101.000-418.000 1639.50
Pi,At'J CHECK FEE 101.000-439-31$ $133.54
MECHA131CAI. FIER 101.000-421.000 moo
ELECTRJCAL FEE 101.000-420-000 $97.49
PLUMBING 101.000-414-000 $136.00
STROND MOTION FEE . RESI D 101-000-2x11-000 $9.93
'
GRADIN01 FEL 101.000-423.000 $20.00
DEVELOPER. IMPACT FEE $1,907.00
w.: p
�.z
SUB -TOrfALC034SiR1TC 0ktA AND AN CHECK
$i,022.764
LE PRE -PAM 3
4� $0,60- `
T(XCA£. PRIL QY FMS DUE NOW
RECEIPT
DATE
BY "
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
p
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
v (
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_ CI
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•� •'fir -
x s vw 'It
12 Y OF:, LA :QUINTA
BUILDING'& SAFETY DEPARTMENT` .
cs'. 7F Mt O
-7.7-70,12;.
MI�INSRECTION REQUEST LINE
717-7153
KSL,DESERTAES.ORT, INC
Owner ;
Contractor. KSL�`LAND..xiI CORPORATION
s:• 0007=296
Permit: Number " 4
POST ON J.OBXIN.CON_SPIC,000S ,PLACE
INSPECTOR MUST,,SIGN ALL APPLICABLE -SPACES
:'49=464�AVENIDA OBREGON
JOB ADDRESS'' "
SFD LOT If PLAN I PEAMITdDOES'NOT
INCLUDE BLOCK WALL OR POOL
COVER NO 'WORK UNTIL ABOVE HAS BEE 'SIGNED
DRYWALL`INTE9I0R!41!'
EXTERIOR LATH ��-
POOL PRE PLASTER
ENCE & GATE
E SEPTIC TANK
FINALS...
PLUMBING"
FINAL GAS -TEST'
H . •VG= �C
H E,NUMBERS
JOB COMPL'-ETEO_
u ABOVE APPROVALS D.O, NOT INCLuOE RIGHT TO
TURN ON UTILITIES'OR OCCUPY BUILQING
qtr
•'..i `p .. .r .._ .. ... 'i.. :1:'... I .. a ..
Certificate of Occupancy-
uinta
"it of La
Y.
Q
Bu#din.g.a'1n,,,,d Sa ,6 Deparlin.,en�t:.Yy
This Certificate. issued pursuant to the requirements of Section X 09 of the 'Uniform Bui/din_4Xode,
Certifying that, at the Gime of JSS§
uance, t '.,&ructure . .a , in compliance with the`•various ordinances -
of the:Cit regulating bui/ding •construction or use: 'For ttie fonowin
BUILDING ADDRESS: 49=464 AVENIDA OBREGON
Use Classification: SFD Bldg. Permit -No.: 0007-296
Occupancy Group: R3 Type of Construction: VN Land Use Zone: TC
Owner of Building: KSL DEVELOPMENT CORP
Building Official
Address: 55-920 ,PGA BLVD
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 4-19-01
POST IN A CONSPICUOUS PLACE
no=