9807-207 (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 DATE
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
747866 9 A0 4i30100
Date 4'" si Signature of Contractor`- A
OWNER-BUILDE DECLARATION a �..+
I hereby affirm under penalty of perjuhatI m 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 &.6 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.
( 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 Policy No.
(This section need not n14 ot be comjpleted if the permit valuation, is ford 100 00 0 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, I hall forthwith comply with%those provis ons.
Jf ate: �� ApplI . & � /�5�/�i
Warning: Failure to secur Workers' Compensatio 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 of
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 i
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 property for inspection purposes.
Signature (Owner/Agent) Z': Date g
BUILDING PERMIT
VALUATION LOT
JOB SITEI 't '
ADDRESS
49-505 AVENIDA OB 1'Of3N
OWNER
KSL DESERT RESORTS, INC.
%-140 PGA BLVD
LA QUIR"rA CA 92233
USE OF PERMIT
r
PERMIT# '
98417437 TRACT
45
APN
28543-2; `
631-390-072
CONTRACTOR / DESIGNER / ENGINEER
KSL LAND II CORPORATION
55-920 POA BLVD
LA QU7I+r4A CA 92253 1
1760)164-7166 CBL# 5323
PLAN 4D ALT - Si:$1- PERivt7T DOES INOT iNCLUDE, BLOCK WALL OR.
POOL. 75% PLAN CHECK REDUCTION APPLYED. LA. QU rA RESORT
CUSTOM CONSTRUCTION 1,680.90 SF
ESTIMATED 1`ED COST OI, L°ONSTRUC ION
PERMIT FEE SM1 IMARY
CONSTRUCTION FEE
101-000-418-000
$748.00
FLAN CHECK FEE
101-000-439-315
$:160.15
MECHANICAL FEE
101-000-421-000
$,137.00
F1,ECFR1CAL FRE
101-000420.000
$116.30
PLU'MBINt, FEC
101-(100-419-000
5:169.75
STRONG MOTION FEE - RES ID
101-000-241-000
$13.09
ORAD.TNG M
101-000-423-000
$,20.00
ir1 RASTRUCPU'RE FEE
225-000-441-342
$2,944.62
AR'r IN PUBLIC PLACTES -4W81: 701-000-25..5-000
= Y,
$77.18
+. R
SUB -TOTAL CONSTRI UrION AND PLAN CHICK
LESS PRE -PAID FRES
1:301872.:190
TOTAL PERMIT FEES DUE O`Zr I S4,386.0.9
RECEIPT I DATE I BY/ I DATE FINALED I 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 _ g
Exhaust Fans
O.K to Wrap
F.A.U.
-
Framing —
Compressor
Insulation _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior lath AI Ad
Drywall - Int. Lath C L
Final
– !-
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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 Piaster
Sewer LateralPool
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 7
Utility Notice (Perm)
COMMENTS: