0007-302 (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
7 428 B OS 31/2(
Date t I 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 nce of the work for which this permit is issued.
(ave 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 7URjCH, yNS.' CO Policy No. WC 633896307
(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, 1 al fo hwith comply with ase
DaApplicant-
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 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 propeLly for iin}spectio�n p rposes. j
Signature (Owner/Agent) `'' " I Date 3 `�
BUILDING PERMIT PERMITS ,
DATE j VALUATION LOT 01007-302 TRACT
717 25:145.3,
JOB SITE r APN
ADDRESS 49-M AVlt,MA OBIRE0011 658-340-026
OWNER I CONTRACTOR / DESIGNER / EN &NEER
KBL, :C7PiV0..0PNIEN T CORPORA11109
55-920 P(3A.1BLV17
LA gJl'.NTA CA 9223
USE OF PERMIT —Dw
IS1NOLE RA3 Y n .«
xs SI. DEiiKWP10W CORPORN110M
55.920 PCTAPI.,VD
isACjiTWA CA. 02253
(760)564.'7166 C}3t# 4676
SFD- LOT:27 PLAN AA ALT- PERMIT DOES NOT INCLUDE BLOCK WALLS
OR POOI..7S%PLA14 CHECK FEED REDUCTION FOR WILTIt LE ISSUANCE
OF sAME PLAN TYPE.
CUSTOM CONSTRUCTION 1,680.00 SF
J=D1XX1W COST OF C0W1[ UCMON
130,1372.00
PEPJWT IEE SUAVAARY
COMTRUCTION IM-
101.000.418.000
$743.00
PLAN CHeCK FU
101-000-439-315
$158.79
MECRA141CAL FEE
101.000.421.000
$130,50
LLECTR)CALFEE
101-000-420-000
$99.30
'
PLUMBING FIiE
101.000.419-000
$171.00
=
STRONG MOTION FEF - RESID
101-000-241-000
$13.09
ORADINCI FRE
101.000-423.000
$20.00
1-3:^ fi
DEVELOPER IMPACT FEZ
$1,907.00
SUB -TOTAL COMST'RUCTiON AND PZ.AW C K CK
$3,248.18
LUS PRF -PAID FEE.9
20.00 .
RECEIPT I DATE
TCYfAL PST MS ME .KOW I $3,246.18
DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
'`W
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Cpmbustion Air
Roof Deck
C-ef
Exhaust Fans
O.K. to Wrap(J_
F.A.U.
Framing
Zo- (A,)
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—
Drywall - Int. Lath
Q..
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
Yf- _ Ori Ak11,.e107
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) �p
COMMENTS:
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying 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:
Use Classification: SFD
Occupancy Group: R3
49-500 AVENIDA OBREGON
Type of Construction: VN
Owner of Building: KSL DEVELOPMENT CORP
Building Official
Bldg. Permit No.: 0007-302
Land Use Zone: TC
Address:
55-920 PGA BLVD
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
1-9-01
I POST IN A CONSPICUOUS PLACE