9807-243 (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 13 4/30/00
Date / 7— Signature of Contractor A
OWN ER -BU ILDEI�DECLARATION
I hereby affirm under penalty of perjury that l 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:
Cartier Policy No.
(This sectioeMotbe c-oFnple ed if the permit valuation isxfo6$10U0.000or 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 withose provisions.
Date:
ate:- Applicant r�
Warning: Failure to secure Wp ked Compensation coverage is unlawful and
shall subject an employer to cnrninal 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, inclem ify�
& hold harmless the City of La Quinta, its officers, agents and emZ9l e
2. Any permit issued as a result of this application becomes null an &v i if
work is not commenced within 180 days from date of issuance of sueh
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 property for inspection purposes.
�j
ignature (Owner/Agent) _ a , i% Date i l
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9807-243 TRACT
!!
�a.A /.n $132,492.711 51 '28545-2 '
JOB SITE] tv
APN
ADDRESS
'
49-625 AV ENIDA Oi441;1' GON
631-380-072
OWNER CONTRACTOR / DESIGNER / ENGINEER
KSL DESERT RESORTS, INC. KSL [.AND II COR.PO AnON
56-140 PGA BLVD 53 -WO PGA BLVD
LA QUTNTA CA 92253 LA QU1NT'A CA 92253
(760)564-7166 C'BL# 5323
USE OF PERMIT
�#4UC.'1���•
PLAN 2A - SF - P1 RMTT DOES NOT INCLUDE B1_C�t. K WALL OR POOL.
7%% PLAN CrCk REDUCTION APPLMD. L.A QUINTA RESORT fiC INIES,
PHASE
CUTf0M CONSTRUCTION 1.674,00 3!:
PORCH;PATiO 1.57.00 SF
ESTIMATE D COST OF CONSFRUCfION
132,492.70
RY
PERMIT FEE SUMMARY
CONSiRUCT10.N FEE 101-000-418-000 $755.00
PIAN—' C -K FEB 101 -W -439-31I3 -5160.21
MECHANICAL FEE 101-000-421-000 $98.30
filECIrRiCAL FEE 101-000-420-000 $1.31.09
PLUMBINCI } IET3 IM -000-419-000 S 174.50
STRONG MOTION FEE. - RESID 101-000-241.000 S.13.25
0R.A.Difv`C'! SEE t01-000-4223-000 $20.00
IN- RAS`t'RUC.IVRE T -E 22.3-000-443-342 $2,934.10
ART 1N PITBI.1r, PLACES - RES[C 7.01-000-255-000 $81.23
r.
k
v.
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SUB -TOTAL C0NSrRUC.7r10N AND PLAN CHECK
4,3fi7.Sl�
/ LESS PIU -PAID I -EES
TOTAL PERMIT FEES DUE NOMr
$4,367,98
a
4
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs G
Underground Ducts
Forms & Footings 44
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck IZ, 2,
Exhaust Fans
O.K to Wrap
F.A.U.
Framing L
Compressor
Insulation Alee
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 It
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines G
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 G
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 G Z
Utility Notice (Perm) — ..SLY 194,11r
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COMMENTS: