0007-305 (SFD)LICENSED CONTRACTOR DECLARATION
1 -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
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
perfor g'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 INS, CO. Policy No. W( 6238965O?
r "
(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, II orthwith comply with e provi t S. ^ J�
Date: _T i Applicant—
Warning:
pplicant 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.
LaborCode, 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 ins ection poses.
Signature (Owner/Agent) ! 1 Date
. PERMIT# +... ,... .., _
BUILDING PERMIT-. _
DATE VALUATION LOT OC107-30STRACT '
7l °r $132,49230 30 MP45-
t ,
JOB SITff
APN
ADDRESS 4.9.:Im,AImTISA 033t1'EEi3d7.Pi'
09-34"".
OWNER
CONTRACTOR / DESIGNER / EN (NEER
X91- DEVELOPMENT CORPORATION
KUL DEM,0P)aW CORPOMrION '
55.920 PGA BLVD
55.920 PGA BLVD
LA QLIDITA CA 92253
LA tt?L7IN TA CA 92253
(/60)564-7166 CHH 4676
USE OF PERMIT
FAMILYPn
SINGLE lat_
SFD= LO'T:30 PLAN::fA- PERMIT DOES NOT INCLUDE BLOCK WALLS OR
POM75% PL" Ctl&'.s,; FEE REDUCTION ICOR MULTIPIA ISSUANCE OF
SAME PLAN TYPE.
CUSTOM CONSTRUCTION 1,674.0 SF
POR.C1-IIPivrio 151.00 SIP
MIMATED COST OF CONS'L'1 Ulff lON
1321492.70
PERMT EWE 01114I"Ry
C-01-12TRUCTICDN FEE 101-000-418.000 015A
PLAT; CHECK FEE 101-000-439-318 $158.35
MEC11"ICA.L "R 101 -At —421.000 $111.06
ELECTRICAL rMEY 101-000-420-000 $99.9
PIXM8IN0 F&F . 101-000x419-000 $163.75
- M
STR,ONCI MOTION F91 -P = RESID 101-000-241-000 $13.23
ORADD40 FEE 101.040.423.000 $201.00
DEvELOPEA IMPACT FE $1,9i17.OQ
�« r"L"� •`-
SUIT-IMAL CONSTRUMION AND PLAN CHECK:
63,227.94
HAS PRE-PAJI3 FF
$0,00
TOTATPi ARES DXTT ?4
_
?:
RECEIPT
DATE
BN % -'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs%
— GQJ
Underground Ducts
Forms & Footings^
- �� (f(f _
Ducts
Grade
Return Air
Steel
-ZSlab
Combustion Air
Roof Deck.
(� 00
Exhaust Fans
O.K to Wrap
_
G't
F.A.U.
Framing
- CO
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls IL
Party Wall Insulation
Condensate Lines
Party Wall Firewall
ol_
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
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
ew Connection
tp
Encapsulation
Gas ping
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
f
Final - Q
Utility Notice (Perm) -
COMMENTS:
La� •c,�
.. r� .:CITY OF'LA QUINTA
BUOLDING & SAFETY DEPARTMENT
F "' 777-7012
INSPECTION, REQUEST LINE
7774153
KSL°:DESERT RESORT, INC
Owner
Contractor, KSL LAND II CORPORATION'
Permit Number 0007-I
POST'ON JOB',IN CONSPICUOUS PLACE
INSPECTOR MUSTrSIGN ALL APPLIGABLE'SPACES
JOB ADDRESS 49'=488 AVENIDA� OBREGON
SFD- LOT 30 PLAN 2A-PERMIT:DOES NOT
INCLUDE BIJOCK WALLS OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION '& SETBACK GQ
FOOTING�STEEL ,
MAIN:GROUND SYSTEM
GROUND, PLUMBING -
PRE-GUNITE
DO: NOT POUR CONCRETE'UNTIL ALL ABOVE, HAS'BEEN'SIGNED
CONCRETE SLAB
JOISTS & GIRDERS:
DO ..OT POUR°CONCRETE UNTIL ALL,ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING'...
ROUGH GAS &' LASTEST
�' <
HEATING & VENT -.AVC
FIREPLACE
ROOF
2
BOND BEAM
O.K.`TO WRAP
c>0
GROUT ❑ 4' ❑ 8'
FRAMING. -
RAMING••INSULATION
INSULA ION'
PRE -ROOF x
:COVER NO .WORK UNTIL ABOVE: HAS BEEN SIGNED
DRYWALL INTERIOR
'
EXTERIOR'LATH';` `
POOL PRE PLASTER .
;FENCE & GATE -
EW RSEPTIC TANK
ABOVE'APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
ffi
-CITY- OF -LA OWNTA,
-
B(j.(LDI NG - a. SAFETY DEPARTMENT
IF 777=7012
INSPECTION,.REOUES-T.- LINE
21�
7.77-7153
`RESORT, INC
KSL DESERT
Owner I •
KSL LAN16'11-
.
1CORPOji.ATION
Contractor
_1060-T116,5
permit Number
P OU PLACE
P0$7ORJOBAN'CONSIC,
INSPECTOR �jST`S,GN ALL APPLICA;::ES_PAWC
E
S
40!488FA, gNIVNTQBREGON
J
JOB ADDRESS _. I -
SFD- LOT 30 PLAN 2A -PER-MIT DOES NOT
INCLUDE -BLOCK WALLS OR POOL
DATE INSP.
TYPE OF INSPECTION
FOUNDATION &; SETBACK,
F06TING'9TEEL
MAIN GROIUND'SY.I.I.. M
GROUND.PLUMBING
PRE_-'GUNITE J HAS BEEN SIGNED
DO NOT
.
4 POUR CONCRETE UNTIL ALL ABOV
Z6_t_4CRETE.SLAB
jOISTS'&--GIRDERS'
ELECTRICAL GROUND WORK
D -p-0UR CONCRETE-UNTIL AL ABOVE,HA&BEIIEN SIGNED
I'
ROUGH ELECTRIC
ROUGH PLUMBING
UGH GAS & GAS TEST
HEATING, &VENT A/C
FIREPLACE
ROOF'
BOND BEAM
O.K. To-WRAP
GROUT 0 4 0 8'
FRAMING
INSULATION
PRE-ROOF
COVER-NO
WORK UNTIL ABOVE HAS,BEEN SIGNED
DRYWALL INTERIOR:'�`
EXTERIOR LAT.
pOOCIPRE PLASTER
pQ0L.FENCEAGATE'
EW R.SEPTIC TANK
ABOVE APPROVALS OQNOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding Code,
certifying that, .at the --time of issuance, this structure was in compliance with the various ordinances
of the City regulking building construction or use. For the following:
BUILDING ADDRESS: 49-488 AVENIDA OBREGON
Use Classification: SFD Bldg. Permit No.: 0007-305
Occupancy Group: R3 Type of Construction: VN Land Use Zone: TC
Owner of. Building:. KSL DEVELOPMENT CORP
J
Building Official
Address: 55-920 PGA BLVD
City: LA QUINTA CA 92253
By: , KIRK KIRKLAND
Date: 1-26-01
POST IN A CONSPICUOUS PLACE