0007-297 (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
342 B 03/3 1 /21
NDate 3 Signature of ContractorO—V
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).
( ) 1, 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 ce of the work for which this permit is issued.
( )iave 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 r14S. CO. Policy No. WC 68N,96507
(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' compensatiorprovisions of Section 3700 of the Labor
Code, tall f'rthwith comply with t ose Provjs1
Date: Applicant t--� ��^- 13
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 pro y for in ecjtiioon pposes.
Signature (Owner/Agent)��k_ Date d
BUILDING PERMIT PERMIT"
t$007-9
DATEVALUATION LOT TRACT
7 $130,872.00 22 2Z545.3
: /
• � � ;
JOB SITE % f
APN
ADDRESS 149-484 AVEMA 013".00N
6W340-0
OWNER
CONTRACTOR/DESIGNER/ENGINEER
XSL D:F MOPMEW CORPORAI3OW
XXL DEVELOPAO.W CORPORATION '
55.920 PGA DLVD
55 -920 PPA 1MjVD
LA QUIRfA CA 92233
LA QU A CA 922,S3
(760)564-7166 03W 4676
USE OF PERMIT
VIP
SI J• LOT:22 PLAWAA• PERMIT DORS NOT INCLUD2 BLOCK WALIZ OI:
Pi70i.,.73yo PLAN C1IL m F&E REWCTION FOR MULTIPLE I.S stSA?WE OF
SAME PLAN TYPE.
CUSTOM CONSTRUCTION 1.680,00 nF
Eb`F M(AI'= C069r O CO Na'`IZUC.'°17014
1R72"
y�-yQ�pte�.n 7�+•�,,'�1 �v;q
P.tl'~i.LY.1.Xii1 .V KE SUACKA
CONGTRUCTTON FEE 101.000-418.000 moo
PLAN CHECK FEE 101-000-439-318 $15&79
MECHANICAL FEE 101-000-421.000 $130,56
MECTRICAL FIDE 101-000-420-000 $0.30
PI..UMDTHO FEE 101.000-419.000 $171.00
STRM40 MOTION FEE - RESID 101-000-241-000 $13,09
CIRADWO FFY, 101.000-423.000 $20,00
17ZVF,1DPER IMPACT P72
:- - f
SOUR -TOTAL C0XfffRUC ON AND PLAAl CIVIC
18
IMS PRE -PAID n- M
$0.00
TOTAL PERMT FEES DUE NOW
$3►t 4S1ii
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
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:
a
Jt4Y OP. LAQUI1.NTA
BUILDING.&-SAFETY DEPARTMENT
F o 777-7012
' 3 L Zvi INSPECTION REQUEST LINE
777-7153;'
KSLllfSYERT RESORT, INC
r KSL LA'ND'II CORPORATION'
Contractor, p -
7, 000�//-277
Permit Number
POST` ON JOB,IN CONSPICUOUS"PLACE
INSPECTORWUST'SIGN TALL APPLICABLE SPACES
49-484 AVENIDA OBREGON
JOB ADDRESS.
SFD. LOT 22 PLAN 4A-PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL
TYPE OP.INSPECTION . - DATE INSP.
'FOUNDATIONA SETBACK, — <%�
FOOT,ING`STEEL l
MAIN; GROUND: SYSTEM
GRQUND,.PLUMBING
PRE°GUNITE
DO NOT POUR CONCRETE UNTIL ALL,ABOVE HAS BEEN SIGNED
TZ 9
CONCRETE SLAB c�ti
JOISTS & GIRDERS
ELECTRICAL GROUNDWORK
sr
DO-wOT POUR,CONCRETE UNTIL ALL ABOVE HAS. BEEN SIGNED,.
ROUGH ELECTRIC
ROUGH PLUMBING'
ROUGH,GAS,&.GAS,TEST
" v HEATING & VENT - A/C
FIREPLACE
ROOF.72
_ I
BOND BEAM"
O:K. TO WRAP = /C... •`� `/ .. �,7
GROUT 0:4' O 8'
ar
FRAMING
INSULATION
PRE-ROOF
COVER NO WORK UNTIL ABOVE HAS BEER SIGNED
L' .. DRYWALL'aiNTERIOR a C.
EXTERIOR: LATH u
POOL PRE -PLASTER
POOL FENCE &GATE
SEVEP SEPTIC TANK
ABOVE APPROVALS'DO'NOT-INCLUDE RIGHT TO
gTUFIN ON UTILITIES OgbCCUPYiBUILDING`'
Certificate -of Occupancy
City of La. Quinta
Building. and Safety Department
This Certificate issued pursuant to` the requirements of Section I09 of the: Un forrm$y %ding, Code,
certifying. that, at the time of issuance; this structure was axomp/iance'with the various ordinances
.. t:. .:. ,. .
of the-: City regulating building construction . or use. For the following:'.
BUI.LDI'NG AD:ORES-S: 49=4.84 AVEN:IDA-OBREG,ON
Use Classification: SFD ` Bldg. Permit `No:: 0007-297 .
Occupancy Group: R3 Type of Construction: VN Land Use Zone: TC .
Owner of Building: XSL DEVELOPMENT CORP
wr#40%
Building Official
Address:
-,.551-920 PGA BLVD
City:
' LA' QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
3-13-01
POST IN A CONSPICUOUS PLACE