0007-300 (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
$Datef.34'783
I I UtJ Signature of Contractor 44,
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
perfo C 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" ZURICH CAIS. CO. Policy No. WC 683E9f5307
(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 Secti n 3700 of the Labor
Code, II f with comply with se pr v Ion
Date: �� Applicant 3M —'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1,00,000, 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 propdiff for inspeo Ion Ur s
16
Signature (Owner/Agent) ' ' Date )
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0007-300 TRACT
$1:12492,70 25 28545-3
JOB SITE
APN
ADDRESS 49472 AVMWA OBREGOkT
&513440-024
OWNER
CONTRACTOR / DESIGNER / EN (NEER
KOL xiF VHLOPMR T CORPORATION
KSS DEVE,01" M14T CORPORA'17014
55-920 PLANT D
55-920MADLVD
LAgUIt+irA CA 92253
LAQ1iINIV, CA 9225:
(760)564-7166 CTS 4676.
USE OF PERMIT
l ]
MNGL E FA .YAT A /
SF+D. DDT:23 PLA.N2B.4 PERMIT DOES NOT INCLUDE BLOCK WALLS OR
POOL,75% PLKN CHECK FEE REDUCTION FOR MUI..TIPLE ISSUANCE OF
SAME PLA14 TYPE.
CL1VOM CONSTRUCTION 1,611.00 SIS
PORCMAPATIO 137.00 SP'
ESTIMAJIM COST Ole COX-0211MO.R
P11WI' FM gUAMtSRY
COMTRUCTIONI FEE 101-000-418.000 M5100
z
PLAN CidWX ice.' 101-000-439-318
"J, @t>
MECHANICAL PEA 101-000-421-000 $111.00-
SLECTRICAL PEE 101-000-420-000 999.59
PLUMBING FEE 101.000.419-000 $163.73
lea
�
STRONG MOTION FEE wMID 101-000-241-000 $I3,25
[�`'-
a.j.
(XAPING PRE 101-000.423.000 $20.00
,y
DEVELOPER IMPACT WEE $1,907.00
e�i•:p w#
EMB -TOTAL. 001191 iiTt"TI N AND PLM CI'liWK
$3,227.94
1WS PR&PAIt)IPEES
$0.00
TOTAL Pig" YKIPS DUE NOW
$21,22704 .
RECEIPT
DATE
BY j� �'
DATE FINALED
INSPECTOR
r.--`
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
00
Underground Ducts
Forms & Footings
V. ov 1,4C
Ducts
Slab Grade
Iv, pv L
Return Air
Steel
Combustion Air
Roof Deck
10- - GX) AV^
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
01 G
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
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
Iva
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 p e
Utility Notice (Perm)_/_/19-01 A(�
CITYPF LA QUINTA-
c F o BUILDWG & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
" `zOOO 777-7153
Owner KSL )PEMRT, RESORT, INC
Corhtractor KSL_LAND II CORPORATION
Permit Numbee. 00.07-300
POST' ON'; J,O,B IN. CON'SPICU'OUS PLACE
INSPECTOR- MUST SIGN ALL APPLICABLE` SPACES
49-472 AVENIDA OBREGON
JOB ADDRESS-
SFD- LOT 25 PLAN 2B -PERMIT DOES NOT
INCLUDE BLOCK WALLS. OR POOL
TYPE OF INSPECTION DATE INSP.
FOOTING STEEL �L
MAIN GROUND SYSTEM
GROUND PLUMBING ;� - / . W liC
PRE-GUNITE
DO NOT POUR;CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB: �. �.c•
JOISTS& GIRDERS
ELECTRICAL GROUNDWORK
DO ..OT POUR'CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED"
ROUGH, ELECTRIC,;
ROUGH PLUMBING'
ROUGH'GASA'GASTEST
HEATING ,& VENT='A%C;`
ROOF.
G .
BOND BEAM'
0. K. TO WRAP
GROUT •• 0: 4' .08'
FRAMING
.INSULATION
— -C/Q
PRE -ROOF
�U 2. ? -�.'-
COVER-NO. WORK.UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR,
e�Q. _
EXTERIOR LATH
POOL -PRE PLASTER'-,
` FENCE'S GATE..
EWE SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FI " ` ',GAS TEST
W"'VG -A/C
HOuSE NUMBERS
JOB COMPLETED
TEMP.,POWER'
ABOVE APPROVALS DO NOT INCLUDE'RIGHT TO
TURN, ON UTILITIES OR OCCUPY BUILDING