0007-304 (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
%L.-Oa
Date Signature of Contractor �— � Y .�
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
performance of. the work for which this permit is issued.
erTFave 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 CJa2IOH 1NM,. CO. Policy No. WC 689396SO7
(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 theworkers' compensation provisions of Section 3700 of the Labor
Code, h fo hwith comply with se pr .iso s.
Date: #� 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, 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 • ectionn pwfp�ses.
Signature (Owner/AgeDate
- BUILDING -PERMIT PERMIT# -- - }
0007-304
DATE VALUATION LOT TRACT
-7 + C <.:. UW92.70 29 2854S-3'_ .
JOB SITE
APN
ADDRESS 49,492 sAiPFNiI.?A OPI 1±.CION
&M -340-02S
OWNER
CONTRACTOR / DESIGNER / EN (NEER
XXL DEVMOPNtWr CU•RPO1010N
KBL DEVELOPIEWT CORPOk ON
55-920 PGADLV7D
55-920 PGA LILVD
I -A CZI. LWTA. CA 92253
LA QUNIA CA 412253
°
('760)5644166 CBU 4676
-
USE OF PERMIT
VKILwI`�
SVD- LOT:29 PLP.N:28. PERMIT DOES NOT INCLUDE BLOCK WALLS OR.
POO1,7514 PIAN CHECK FEE REDUCTION FOR MUUfIPLE ISSUANCE QP
SAME PLAN TYPE
CUSTOM CONSTRUCTION 1,674.00 Sly
PORCH/PATIO 157.00 S.Y
ESTDAAT1~:D COST OF C.ONS"IfMCTION
132,4.92.7D
PERAW FEE Whdi."RY
CONSTRUCTION FEE 101.000-418-000 s7ss.00
PLAN CHECK VEZ 101-000-139=318 $138+,15
MECII"ICAL FEE 101.000-421.000 $141,00
ELECTRICAL FEE 101-000-420-000 $99.59
' . ^T f
PLUMBING ISE 101-000.419.000 $163,79
STRONG MOTION FEE - RESID 101-000-241-000 $13.WS
OPADING FLEE 101.000-423.000 $20,00
DEVELOPER IMPACT FEE $1,907.00
N•.2 1
».1
•r.t
SUB-TOTA1. CONSTRCTCTION AND PLAN Cfft'-Zf:
$3,227.94
LESS PRIT-PAID T4RO
$0.00
OTAL .PL" F MIX05 DVE NOW
,2.27�94'
RECEIPT
DATE
B /
DATE FINALED
INSPECTOR
:. -
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
_. GiJ
Ducts
Slab Grade
_ O
Return Air
Steel
-
Combustion Air
Roof Deck
d
Exhaust Fans
O. K. to Wrap
_
F.A.U.
Framing
Compressor ? —
Insulation
Vents 1
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- Ce j
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
J
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 •.-Q
Utility Notice (Perm)
COMMENTS:
s CITY OF LA QUINTA
`Bd ING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE.
777-7153
Owner KSL DESERT. RESORT, INC
Contractor KSL LAND II CORPORATION
Permit Number
0007=304
POST ON JOB, IN CONSPICUOUS PLACE,
INSPECTOR MUST SIGN ALL.-.APPLICABLE SPACES
roe ADDREss 49-492" AVENIDA OBREGON
SFD= LOT 29 PLAN 2B; PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION& SETBACK
FOOTING-STEEL►
MAIN GROUND'SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB 600
JOISTS& GIRDERS
ELECTRICAL GROUNDWORK
W-NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS .GAS TEST. C,•,' :..� '
HEATINGA VENT- A/C
FIREPLACE
ROOF v"/2 ESC Lc
BOND BEAM
O.K. TO WRAP lU T-
GROUT ❑ 4' ❑ 8'
FRAMING �> .� - C'✓
INSULATION
PRE-ROOF
C0VER.NO WORK'UNTIL•ABOV .HA$.;t3EEN.SIGNED
DRYWALL INTERIOR >
-EXTERIOR LATH'
POOL PRE PLASTER
FENCE"8 GATE
EWEOR SEP71C TANK: ' U
FINALS
ELECTRICAL
PLUMBING, '
FINAL GAS TEST
F; 4G,, AIC
H E NUMBERS
J08 COMPLETED
TEMP POWER
ABOVE APPROVALS DO.NOT INCLUDE RIGHT TO
TUWON UTILITIEsbWoGCUPY BUILDING
Certificate of Occupancy
City- of La'Qu*inta
Building and Safety Department
This.. Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
ceitifying .that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 49-492 AVENIDA OBREGON
Use Classification: SFD Bldg. Permit No.: 007-304
Occupancy Group: R3 Type of Construction: VN Land Use Zone: TC
Owner of Building: KSL DEVELOPMENT CORP
Building Official
Addr=ess:
55-920 PGA BLVD
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
1-23-01
I POST IN A CONSPICUOUS PLACE
;00