9807-242 (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
[
Date / Signature of Contr!actor�
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
1 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.
uluc� 1N£si,'Ri11�CE wc+s;�qr;. )
(This section nee no be competed 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,
Yj 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 379P of the Labor
Code, I sf II fortwith comply withthose provisions.
V1, ate: Applicanttl
:zWarning: Failure to secure Werke s' 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
f(?r_.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 cancellati0
I certify that I have read this application and state that the above inform on is
correct. I agree to comply with all City, and State laws relating to the build Q
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prope��for inspectitioon /peurrpposes/ 17
Signature (Owner/Agent
BUILDING PERMIT PERMIT# -
4� ,
DATEVALUATION LOT 9807x42• TRACT
J
/
JOB SITE
APN
ADDRESS
49-015 AVENIDA t3HRE'GON
01-380-072.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KSL DESERT RESORTS, INC.
;'GSL LAND H CORPORATION
56-140 PGA BLVD
55-920 PGA BLi')
LA QUIN TA CA 92253
LA QUINTA CA 92253
f'760)564-',166 CHL# 5323
USE OF PERMIT
PLAN 2B - SFS- PERMIT DOES NOT INCLUDE BLOCK WALL OR POOL.
750% PLAN CHECK REDUCTION APPLIE-FID. 1.A QUINTA RESORT HOIXIES,
n. .
CUS'TONI CONSTRUCTION 1,674.00 SF
P .)RCkFPAT7.0 157.000
LSITIMATED COAST OF CONSTWO.CTION
I32,4921711'
1?EI M11T FEE SUMMARY
CONSTRUC'.i`lON rM- ' 101-000-41151-000 $755.00
PLAN cIECK FEE t01-000-439-318 s lsu.21
MECHANICAL FEE 101-00042.1-000 .198.50
EiucrwCAL FEE 101-000-420-000 5131.0
PLL&W[NO FEE 101-000419-000 $174.50
SI RO.NG NIOT.ION FIFE - "RES1D 101-000-241-000 $13.25
GRADING FEE 101-000-423-000 $20.00
1 rR. STRiIC't`117i.F. FEe 225-1000-443-342 $2,934.10
ART fN'PU LIC PLACES RLC 701-000-255-000 $81.23
5 '
SUB -TOTAL CONS" RUCTION AND PLAN CHECK
$4,367.88
LESS PRE -PAID PEES
$0.00
TOTAL PERMIT FEES DUE NOW
t
e
$4,367.85
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs - /. _ i
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
14<
Steel
Combustion Air
Roof Deck _la
0. K. to Wrap (,G
Exhaust Fans
F.A.U.
Framing
Compressor
InsulationVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath ,A2
Drywall - Int. Lath
Final
L,
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
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 L ,
Appliances
Final
COMMENTS:
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 G _ Zt
Utility Notice (Perm)