9707-008 (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
734283 B F *" ""3 31/90,
Date 1�t Signature of Contracto t
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(This s6bi%r� neehotr'e completed if the permit valuationti'sW$100% 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 those provisions.
.Date: Q Applicant r}f TR 1
jo. v
Warning: Failure to secure Workers' Compensation coverage is uMpWful 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, 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 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.
,/Signature (Owner/Agent)11 1 I ate��Y
BUILDING PERMIT PERMIT# CONTROL#
' 5470
DATE_ VALUATION LOT 97787-008 TRACT � + •
�
1 �r � S f1A:2fl1.9f1 1 �113attS-1
Job -SITE
ADDRESS
.. ' i9 -&KO RIVIFR
7fr _ illi
OWNER
CONTRACTOR / DESIGNER / ENGINEER
KSL LAND 11 d0RP
KSL DEVELOPMENT CORP .
55140 PGA BLVD
55.140 PGA BLVD
LA Qt.>IN C',A. CA .92253
LA QUINTA CA 92253
(750)771-3642 t`BL# 4676
USE OF PERMIT
Sh i)> LOT I - tRg'i ER PLMN 2C.
CU Tt'M COIJB`i`1 l,iC'f ON 2,379.00 SF
.PG117CTiJPATICI `. 20100 SF
= CARACtr4CARPOR.T 622.00 Sir
ESTIMATED COST OF CONS)'RliXtION
200,201.90
put(MIT EEE SUMMARY
PIAN (CHE+t K 1'1+:F 101-000-439-31:8 $816.14
CONMUCT10N MZ 101-000-418-000 $993.00
1V}I:G'11sWCAL ,F M. $98.50
ra.Wr.RICAL a:N ; : to]-Ooo-420-teat) 5153 �J%
PLUMBING FRE .101-000-41.9-000 $193.25
31'ii1`iCl'MOTIONFfE-RESID 101-000-291-000 $20,02
GR.ADINGnT �. � 101-0a04JI -000 `620M
1.+r1lRM.T.1 WITU]REFE81 1 '` 225-000-44.1-342- $4,444_(►-
XWF IN PUBLIC PLACES-1Lf;•SlIC 701.-000-255-000 8230.54
*10Tr L CONS'T12.UCTION AND PLAN CKC K
$ti,968.81
VG LESS PRE -PAID HIES
$0,00
TOTAL PERMIT FF .5-PUENOW
SS,XB.RA
RECEIPT
DATE
?Y
DATE FINALED
INSPECTOR
s
.y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APP
OVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings
Ducts
Slab Grade A
Return Air
Steel
Combustion Air
Roof Deck /
Exhaust Fans
O.K to Wrap / &
_
F.A.U.
Framing
Compressor
Insulation Z /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
07f_�
Final
Final
BLOCKWALL A
—
PROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
I
Gas Piping
PLUMBING APP OVALS
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 A,
14,
Pool Cover
Sewer Connection IMI
7
Encapsulation
Gas Piping -,2
- a
Gas Test
— Q
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL A
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)
PROVALS
COMMENTS:
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 1
Owner of Building: KSL LAND II
79-850 RIVIERA
Bldg. Permit No.: 9707-008
Type of Construction:.. VN Land Use Zone: RL
C
Building Official
Address: 56-140 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 3-9-98
POST IN A CONSPICUOUS PLACE