9707-011 (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
r —
/ 7-341q B+ 69v� Date ' !Signature of Contractor a'"�V`'' '!
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.
(;q 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.
e5JRIi.'H.INS. CIO. QVC 6938900,5
(This section need not be completed if the permit valuation is for $100.00 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' compensat o provisions of Sectio'n``3700 of the Labor
Code, 1 6l f - rth 'th comply with t ose'-pro .isio s
Date: t' Applicant l
1 t
Warning: Failure to secure Workers' Compensation coverage is unlaw u1 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 propertyJor inspection purposes.,
Signature (Owner/Agent) Date C✓ t
{
BUILDING PERMIT PERMIT# CONTROL#
/M= rY ,L�l
5471
DATE Q VALUATION LOT TRACT
(J 1 R . 5179,' 92".511 4 X340 -.I
SITE 7
JOB SITE
ADDRESS 79$5111tCVUE1i1:�.
APN
761-550-0114JOB
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KSL LAND 11 CORP
KSl.. DFVELOPMENIT COP P
M140 PGA.'i IND
56140 PGA BLVD
LA QUINTA Cts 92283
LA QUINTA CA 92253
(760)771-3642. CBLA 4676
USE OF PERMIT
Sf"fJ
SF'I?. LOT 4 - RY17ER PLAN :I AR.
PLAN CHFCKF'EERMUCWAY 0.5%FOR. MULTIPLE- iSSfJROF SAME
PI,.AN ` TPE.
CUSTOM CONS'TRUC'.rION 2.101.00 ST."
PORC1! IPWrIo 230,60!5F
CARAU"'>?,lCA.RPORT 635,00 SF
t+:S" VINIA.-1 co COST 1,11+' CDNSTRUC..f1QN
179,192.50
PERNI.1AT FEE SUMMARY
C'ONSTItUC' I[ON•FEE 101x000-418-000 $919.50
PLAN QMCK M 101-M-43+3-318 $188.74 .
NZC14A2*SJ:CAL FEE101-UCID=4°I i -1}00 S'79.OU
ELEC WI[ Lpi s "101-000-420-000 5143.76
PLUMBDI rte. --�- 101-000-419-000 167.5
S9'iJNt3MOTION FEE.-1E:S1D 101-000-2-41-000 51.7.92,
GRl#fJWO FM, $20:100
INIr,RA`3`I'fiLkC"i'iJtil;C'; E . 2'2000-443-342 X63,963.00
r1'R'I' IN WiJEliti.fC 1?i,.ACL.S- R>,gla� 701-00A-255-000 S1y 7.98
•
`e s
-
t t �q� �+�yS /.
,M.i, 1..4.E ' l lt�.t<.al O AND PLAN CRECIc,
- 30 7. t j
AUG 01 1997. . LESS PkIi-PAID FEES
$0.00
1'OT4*tL- PERM)1` :CE.[t:S 'DUT NO*A'
S5,697.1$
Yd
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
A
Ducts
Slab Grade
Return Air
Steel
C11
Combustion Air
Roof Deck
%
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
? i
Compressor
Insulationz
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
y
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
7
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—Q
Y_ _i�
Gas Test
Appliances
Final
Final
Utility Notice (Gas) Q
ELECTRICAC 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:
i`
Certificate of,Occupancy
City of La Quinta
Building and Safety Department OafmE°``�
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:
79-880 RIVIERA
Use Classification: SFD Bldg. Permit No.:
Occupancy Group: R 1 Type of Construction: VN Land Use Zone;
Y
Owner of Building; KSL LAND II
Building Official
9707-011
Address: 56-140 PGA BLVD.
RL
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 3-11-98
POST IN A CONSPICUOUS PLACE