9807-241 (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 a230100
ate Signature of Contractor(—) 2,4
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
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.
Ln71c r b,e e wC643� 506
(This section need�no�be completed if the permit valuation is for �100.�0 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. /�
Date: s n Applicant r'° - //
Warning: Failure to secureWor rs' 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. It
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 su�y
permit, or cessation of work for 180 days will subject permit to cancel n-�-
I certify that I have read this application and state that the above informations'
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
thee above-mentioned property for inspection purposes.
I'gnature (Owner/Agent)/ y / /i?' A Date 1�1
024
7
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9XO7-241. TRACT
--,:, $130,872.00 498545-'
JOB SITS APN
ADDRESS
49L-585 AVE IMA OBItE4C"ON 631-390-072
OWNER CONTRACTOR / DESIGNER / ENGINEER
K.SL DESERT RESORTS, INC. KSL LAND 1I COR.PORMIO'N
5e-140 PGA BLVD 5.5-920 PGA BLVD
LA QLTMA CA 92253 LA QUINTA CA 92253
(7W)564-7166 CBI,# 5323
USE OF PERMIT
DLjetljf\
PLAN 4A ALT - SFD - PEM41T DOES NOT INCLUDE UOCK WALL OR
POOL. 75% PLAN CHECK REDUCTION APPLIED. LA. QUTNTA RESORT
CUSTOM CONSTRUC'fIO N 1,610AO SF
ESTI.RIA'ITE13 COST Olt" CONSTRUMON
PERNOT F EE SUMMARY
CONSTRUCnO:N FEE
101-000-118-000
$748
PIAN CHECK Fa"
101--1300-139-318
$160
M E04 AMCAL, FEE
101.0(10421-000
$137
EL.EC'C UCAL, EEE
101-000-420-0013
$116
PLUMBING F Ml
101-000-419-000
$169
STRONQ MOTION FEE - RESID
101-000-241-000
$13
GRADING :FEF
101-000-423-000
$20
fivHlEt.K7`ttUC�"I"UI .:
22?4i00-943-342
$2,914
ART 1N PUBLIC PLACES = EKE 701-000-25.54000
$77
1
SUB-1yMA.L CONSTRUCT`nON MND PLAN CHECK
LRSS F'.RE-PAID F
.00
.15
'00
.30
.7�
.09
.00
.62
.18
130,872.00
$4,386.09
$01110
TOTAL. PER34ii1T FEES DUE NOW 1 $4.3861.09
RECEIPT I DATE I BY / v I DATE FINALED' " I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—lU 94ew
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
- —
F.A.U. lJ'
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & 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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
17
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
7P
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 . Z
Utility Notice (Perm) Eg
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