0007-284 (SFD)LICENSED CONTRACTOR DECLARATION -
n 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
3342 3 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 hce of the work for which this permit is issued.
Gave 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 INE). CO, Policy No. VAC 633106:107
(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' compensate provisions of Section 3700 of the Labor
Code, I sha I ort 'with comply with tP=fv
s.
Date: tfl3Applicant h
Warning: allure 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, indemnity
& 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 or i s e' tion p. os S.
Signature (Owner/Agent) +� ( Date Cl/
BUILDING PERMIT PERMIT#
OW. 1-2 8 4
DATE VALUATION LOT - TRACT
JOB SITE/
APN
ADDRESS 49 AVi�I�; A 01=00N
M
.658-340-009
OWNER
CONTRACTOR / DESIGNER / EN (NEER
XST, DEVELOPh4194T CORPOR.AMON
KOL IYEV1rJ.OP11ONT CORtPOR PITON
55-920 PGA BLVD
55-920 PGA BLVD
"LA QUIWA CA 92.233
LA QUINTA CA 92253
(760)564-7166 CB1.4 4676
USE OF PERMIT
��
SIM- LOTS PLANAR kafERIMIT DONS NOT INCLUDE BLOCK WALLS OR
POOLWX PLAIN CH1:C'CK FE RMUCTION FOR MWAIPUR ISSUANCE OF
SAME PLAN TYPE.
CUSTOM CONS RUC'. TION 11600.00 SF
Ei; mwixw cov of COmmSJmov
)3D,972.00
P-00= FEE 90hUdARa Y
CONSTRUCTION FEE 101-000.418-000 5743,00
PLAN CHECK FES' 101-OCt0-439-318 $11$.73
ME, CHMIC.AL FEE 101.000-421.000 $130.50
ELECTRICAL PRE 101-000-420-000
PLUMB NO ME 101.000.419-000 $171,00
STRONG MOTION IEE - RESID 101-000-211-000 $13.09
y� rt. I
ORAru1NG PCE 101 -OW -423-000' &20.00
.. .
DEVELOPER IMPACT 1E" $1,907.00
� � • '>
Stir-TO10I> COWs&MUCITON AND PLAN CMCSK
�3,24F1.1 E�
LESS PRE -PAID FJWZ
$0.00
TOTAL PEFLAM FEES DUE NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
`._
r
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
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 r
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
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:
M
Certificate of Occupancy
City of La Quinta
Buildin-9,and'Safe v Department
This Certificate issued pursuant °to -_-the requirements, of . Section 1-09 of, the Uniform 'Bui/dig,;Code,
certifying `that, af`ttie. time of issuance,{ this. structure was in comp/iance:.witM.1he: various ordinances
of the. City regu/at ng building tongtruction or:ruse. For the fo/%wing:-
BUILDING ADDRESS:" _ 49-466 AVENIDA OBREGON
Use Classification: SFD Bldg. Permit. No:: 00077284
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:
-1A-`QUINTA CA`92-253
By:
KIRK KIRKLAND
Date:
4-12-01
POST IN A CONSPICUOUS PLACE
TATY, OF LA QUINTA r
F<.�r 4)
� ljQG'.;&,SAFETY DEPARTMENT
• N; 777-7012
1N9R CTIONyREQ-EST LINE
77, '7153
w. KSL.DESERT RESORT, INC z
OWner, ;
Contractor KSL LAND'pjl-CORPORATION
Permit Number
POST ON JOB INCONSPIC000S.PLACE
INSPECTOR MUST SIGN ALL-'APPLICABLE,SPACES
49-466tAVENIDA OBREGON
JOB ADDRESS
SFD-LOT 9 PLAN 4D PERMIT DOES: NOT
'epi,. '
INCLUDE BLOCK`'WALL OR POOL
y,
TYPE OF:INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL '
MAIN GROUND SYSTEM.•.' x'
GROUND PLUMBING rT
PRE=GUNITE+
DO:NOT POUR'CONCRETE.UNTI0ALv.,ABOVE HAS. BEEN SIGNED
CONCRET6SLAB
JOISTS & GIRDERS:._, a
ELECTRICAL GROUND;WORK:.
DL :.JT;POUR, CONCRETE UNTIL ALL ABOVE HAS BEEN SLGNED
ROUGH ELECTRIC
ROUGH'PLUMBING
ROUGH'GAS & GAS:TEST
HEATING & VENT A/C
FIREPLACE, r'` Vii•
ROOF
BOND BEAM
O.K. TO WRAP 0
GROUT 0:4'• 0-8' '
FRAMING Cr (_
INSULATION ` ;.. ' + .0
PRE-060F%
LCOVER NO;.WORK! UNTIL ABOVE HA$;BEEN SIGNED '
DRYWALL INTERIOR
EXTERIOR LATH. '., u 7 Y •:) Alz
POOL- PRE PLASTER
GATE
ENCE &
E SEPTIC TANK ":,�,••C, '
�. •FINALS,;...
ELECTRICAL
PLUMBING
FINAL.GAS TEST
Hl..,oE NUMBERS'•
JOB COMPLETEL)`',..
TEMP POWER, -
ABOVE APPROVALSDO NOT INCLUDE.RIGHT TO::
TURN ON QTILITIESOR OCCUPY BUILDING`,