9807-239 (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
747866 B 4/30100
Date Signature'of Contractor QYNr lA.
�
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.
( ) I have and will maintain workers' compensation insurance, as required by
Sei'tion 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.
06
(This sectio ee iit'bSe comple ed if the permit valuation is f( $100 a0 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, I shall forthwith comply with hose provisions.
Sate: Z A''-1 Applicant � l
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person''at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance Of such
permit, or cessation of work for 180 days will subject permit to cancellatior��
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the buildiKig,-
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Mature (Owner/Agent) /.__ Date w
BUILDING PERMIT PERMIT# 1
DATE VALUATION LOT 9H07,2331 TRACT
SI 32,492.70 47 eat{as-z
JOB SITE , It I —
APN
ADDRESS
49-545 AVE'llfI DA OBREGON
63$-380-072
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KSL DESERT RESORTS, INC.
K.SL LAND II CORPORATION
56-i 40 PGA BLVD
55-920 PGA BLVD
LA QUINTA CA 92253
LA QidINTA CA 92253
(760)564--7166 CB119 5323
USE OF PERMIT
G
PLAN 2A - S o - PERMIT DOHS RIOT •INCLUDE BLOCK WALL OR POOL.
7$8% FLAN CHECK REDUCTION APPLIED. LA QUINTA RESORT HOMES,
PR RF I
CUSTOM CONSTRUCTION 1,674,00 SF
PORCRPATIO 157.00 SF
ESTIMATED COST OF CONSTRUCTION
1324017, 0
PER11UT EEE SI7Mt0URY
CONSTRUCTION FEE 101-000-418-000 $753.00
PL AN CRiECK FELE 101-000-439-318 S160.21
W..CHANICA.L FEE 101-000-421-0(20 $98.50
ELECTRICAL FEE 101-000-420-000 $ I31.09
tJAMI 13ING FEE 101-000419-000 Sl?4.50
STRONG MUr ION FEE - :f BSID 101-OW241-000 $13 25
GRADING FEE 10.1-000-423-000 520.00
IN1:RAS'rRiSC`JURF~FEE 2'2S-t2t2 443-312 $2,934.10
ART .IN PUBLIC PLACES -'F�`1ESIC 701-000-255-0021 $81.23
;� .
s,
SL.IB-TUTAL C ONS'MUCTION AND PLAN CMC K
$4,367.88
117LESS PRE -PAID l�E S
$iO.L`il
TOTAL, PEIf Mff FEES DUE NOW
$4,367.88
RECEIPT
DATE
BY i
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _ Qj -
61,f
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 Z. Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
ef
---------------
Final
2
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines CC, -
�"
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: