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9801-044, 9804-128 (SFD)LICENSED CONTRACTOR DECLARATION l."reby 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 I. Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. DDate, Date Signature of Contractor '' :f --� 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). ( ); 1, as owner of the property, am exclusively contracting with licensed contractors to construct ,the project (Sec. 7044, Business & Professionals Code). O 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 p rformance of the work for which this permit is issued. I(& 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. ZURICH INS. CO. WC 6838%506 (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, 1 -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 sh 11 forth ith comply with those prove ons. Date: / Applicant,� ,�?✓ r!' `s '� •s -c;�" . Warning: Failure to secure Workers' Compensation coverage Is unla%AIUI 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,a11 City, and State laws relating to the building construction, and hereby authorise representatives of this. City to enter upon the above-mentioned property fo(inspection purrpases. cv� Signature (Owner/Agent)' % /J' d % Date - : BUILDING PERMIT PERMIT# °°NTR°`" DATE —.-VALUATION, - . LOT 9.101`•+!/44 TRACT min $217,1127.90ry JOB SITE ADDRESS 79-"3 RIVIERA76?!-dli"31. JAPN OWNER \ / NTRACTOR / DESIGNER / ENGINEER KSL LAND IR KSL .DEVLLOPNIEW CORP 5' r0 rOA BLVD � 5'920 FCi BIND . LA QUIN A CA 9225:, LA. QU1NTAr `: CA W253 (760 =1.7166 - CBL# -} 46116 USE OF PERMIT. `dJ;, LOT 2.1WRITAGE PLAN 2A,02. -'P� JAN 0 81998 ; - Pte""' CITY OF IN CUSTOM CONSTRUCTION 3,32+.00 SF PORCRIPATM a 364.01so SF GARAGEICARPORT 8^ 7 -fel sF i EST IltriXfV, 0 COST Or CONS'I'RUC•xiON 17-7,117.90 . PERMIT :PEE SUMMARY CONS'1RUCCIGNtFa I01-000-418-000 $1,:252.50 PLAN CfMCKFEE. 101 -OW x#39 -3I$ $1,02,7:36 A1P. HANIC L FEE 101-000-421.OW $92.60 ELECT PUICAL 17 -EE -:101.000-420-000 $i$7, I2 PLUMNO.1:M 101-0004,19-000 a'319:Z STRONG Iv1C?TION FEE - RESID 101-000-241-000 $27.71 GitIWIN40 FM 101-000-42:3-000 120,00 INF°i ASTRUC CURE .FEE 2254W-443,342 $600:1+0 ART IN PIJ.I3LfC PLACX3 - RE.%11r 701=01)0-25'1-000 V42.82 SUB-TC71'AL CONSTRUC nON AND PLAN CHECK MESS PR1r-Pull FEES $0.01 "TOTAL PERMIT FEES DUE NOW $.9,2.79.06 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD d OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings a Ducts Slab Grade Return Air Steel Combustion Air Roof Deck j Exhaust Fans O.K. to Wrap — —Q F.A.U. Framing _ (o _ .�. Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath _Q Drywall - Int. Lath _ y Q �,cs AK Final Final BLOCKWALL A PROVALS 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 - Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection zd - Encapsulation Gas Piping Gas Test - 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 Utility Notice (Perm) COMMENTS: S Or'L tw"r- %�' • �Q �1 LICENSED CONTRACTOR DECLARATION ,rfr� kL-hereby affirm under penalty of perjury that I am licensed under provisions of /<, D1 ?` Chapter 9 (commencing with Section 7000) of Division'3 of the Business and N W Professionals Code, and my License is in full force and effect. O = License # Lic. Class Exp. Date r a �3�2 ._ B 3111199 cfl,ZZ r'— tDate Signature of Contractoro/�f J UOWNER-BUILDER DECLARATION W WW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z( ) 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 LO (N 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. 7jJP.1C14 INS. CO. WC 6F.211396506 Ik (This section need riot 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 anyy.mann rso as.to become subject. to..the._..._. workers' compensation laws of California, n�l� agree that if I should become subject to the workers' compensation pfIL( sion`� of Section 3700 of the Labor Code, I°shall forth'With. omply with�those vis�ons. yDate: f� .f"' -111.4 f Applican3� ,- f �Warning:`Failure to secure Workers' Csompensatio�overage 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. 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, an State laws. relating to the building construction, and hereby authorize reprg entatives of this City to enter upon the above-mentioned property for nsW5 on p 'rposes. /Signature (Owner/Agent) - � Date ►' - , BUILDING PERMIT PERMIT# +• CONTROL'# DATE TRACT -'7 % VALUATION $19,478.40.40 LOT -2. .4,1f � 9 / ADDRESS' RIVIERA79-993APN -�E W CSD OWNER CONTRACTOR / DESIGNER / ENGINEER KSS LAND Iff . KSS lir."Al .01PNEINT CORP 55920 VGA BLVD 55920 PGA i IAM LA QI.1[NTA IOCA 92253. LA QUIN'I'A CA. 92253 (760)_5&1-1166 CBL#. . 4076 USE OF PERMIT , MISC ;iti?.t'i.�Ati?N'rAa �t°c,tB]iIv11°f't#9�oi.-04�. U-tiAlv�ilde':: HTt�3i'tt•9,ifl�ii:i'e,�ac�i: K PA% PLAN 2A -02'I C► .i f[RITAt„18.1.11,AN 3943-2. CUSA M CO STRUC:slONtt 21 i.30 3F �e PORCt3ft'A'.f 0 05.00 SC; ' ni � ® ®F LA Wlt4T GARACfF)C: RPOIJT 50.00 SF ` ESTIMATED .11J` \.{15-91 0.`F WaO'i.VSTRUC At =1 19,478A0 i��.i`IiO�AIp.. �'9J B.I �Q3`ifif�.A Q•L .l� - �br3i�fS'1'2E<CEC.�T`1C`1'iJ Fl�i 1"01=t7f}iD-A#:$••C)f1t1 ;���.St� X39 -31i3 --- --- $6',1(�- ttl1.C[;� td1rA1 I' 101-000-421•0(;17 :=.50. 101-0W-420-t)W IILIJM18 N1iF;P..f3 101-000-419-000 `•o'FT��Fi��.<;nn�t}�r��+ftl�.y'Wyf'�f)rW"aF:S;. ^�4j�ll-r©1(19���; 3�QI../�1(/1jftjl 'VY94� DIPI , 31.11" 101-000'•.,2-U00 , .. WFIR.Ikslf1t11i:'t''l'J T11 FE.0 225-OW443-342 ART 1N P1..JT3L _ PLAt.FS -RU- PE 701-000-141,531.000 ,$A830 3.TCYfACO:PI iPLtJr 1 IG ,�lN� I'!�+1 �,'1.1FCK ';2 s 7!4 ESS PRE-PA.i1"E FE S 410.00 i'f5'.1'Ato PE"RM I T 1»`C 9 f I C NONV 5265.79 LP5 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD J OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck S`- Exhaust Fans O.K to Wrap _ -/C) - ?/r F.A.U. ' Framing -. 40 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 - 1 Final Final EJF__t I Zj 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 Water Piping �- Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection (B_� Encapsulation Gas Piping Gas Test o Z - 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 .Utility Notice (Perm) �G COMMENTS: Coachella Valley Unified School District P.O. Box 847, 'Thermal, CA 92274 (760) 399-5137, Ext. 235 Project Name: This Box For Dlstrlct Use Only CERTIFICATE OF COMPLIANCE (Government Code 53080) PGA WEST - THE HERITYAGE COLLECTION Date: Apri 1127, 1998 Owner's Name: KSL Development Corporation Phone No. ( 760) 564-7166 Address: 79-993 Riviera, La Qu i nta , CA 92253 Project Description: Addition to existing :home under construction APN; 761-480-031 Tract #: Type of Development: Residential XX Commercial Lot #: Total Square Feet of Building Area: 228 Sq. Ft. Industrial Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is autorhized to sigh on behalf of the owner/developer. Dated: Apri l 27, 1998 SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE): Gov. Code Gov. Code Project 53080/65995 65970 Approval Number of Sq./Ft. Amount per Sq/Ft. Amount Collected `228.00 $ -0- $ -0- Agreement Existing Not subject to fee prior to 1/1/87 requirement. Note: Fees already paid at 9,000 dollars Mitigation Fees on 12j9 By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge Certificate -issued by: Elsa F. Esqueda Signatur Facilities Analyst NOTICE: Section 66020 of the Govenument Code enacted as Assembly Bill 3081, set forth as Chapter 549, Statutes of the State of Califomia,1996 effective Jan. 1, 1997, requires that this school district provide a written notice to the project applicant at the tune of payment of school fees, mitigation payment or other exactions. This notice is to advise you that any protest in regard to such amounts or the validity thereofin accordance with Section 66020 of the Govenmlent Code and other applicable law, cohmnenoes with such payment or performance of any other requirement as described in Section 66020 of the Govenunent Code. Additionally, this notice advises that the protest thereof must occur within 90 calendar days thereafter. Note: AB 2926 and SB 201 fees are capped at $1.84 per square foot for all residential construction, and at $0.30 per square foot for commercial/industrial projects. Dev. Fees Disk: Misc\Cert-Com Sam (REV. 1/97) DEVELOPER FEES PAID AREA: QQ AMOUNT: $ RCPTA IMM CA.9H: BVUM1.4i: DATE: CERTIFICATE OF COMPLIANCE (Government Code 53080) PGA WEST - THE HERITYAGE COLLECTION Date: Apri 1127, 1998 Owner's Name: KSL Development Corporation Phone No. ( 760) 564-7166 Address: 79-993 Riviera, La Qu i nta , CA 92253 Project Description: Addition to existing :home under construction APN; 761-480-031 Tract #: Type of Development: Residential XX Commercial Lot #: Total Square Feet of Building Area: 228 Sq. Ft. Industrial Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is autorhized to sigh on behalf of the owner/developer. Dated: Apri l 27, 1998 SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE): Gov. Code Gov. Code Project 53080/65995 65970 Approval Number of Sq./Ft. Amount per Sq/Ft. Amount Collected `228.00 $ -0- $ -0- Agreement Existing Not subject to fee prior to 1/1/87 requirement. Note: Fees already paid at 9,000 dollars Mitigation Fees on 12j9 By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge Certificate -issued by: Elsa F. Esqueda Signatur Facilities Analyst NOTICE: Section 66020 of the Govenument Code enacted as Assembly Bill 3081, set forth as Chapter 549, Statutes of the State of Califomia,1996 effective Jan. 1, 1997, requires that this school district provide a written notice to the project applicant at the tune of payment of school fees, mitigation payment or other exactions. This notice is to advise you that any protest in regard to such amounts or the validity thereofin accordance with Section 66020 of the Govenmlent Code and other applicable law, cohmnenoes with such payment or performance of any other requirement as described in Section 66020 of the Govenunent Code. Additionally, this notice advises that the protest thereof must occur within 90 calendar days thereafter. Note: AB 2926 and SB 201 fees are capped at $1.84 per square foot for all residential construction, and at $0.30 per square foot for commercial/industrial projects. Dev. Fees Disk: Misc\Cert-Com Sam (REV. 1/97) f s C V h `tL`bhY &OF LA QUINTA OF ` ` L`bh SAFETY DEPARTMENT 777-7012 JAN 0 8 199UNSPECTION REQUEST LINE 777-7153 � r R kPATND uI Contractor. si_ ,ny VET .0PAw C'nRP Permit Number 9801-044 POST ON JOB IN CONSPICUQUS PLACE -INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 79-993 RIVIERA SFD LOT 2 PLAN 2A -G2 TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING DL PRE-GUNITE , DO NOT POUR CONCRETE UNTIL ALL ABOVEMAS BEEN SIGNED CONCRETE SLAB - JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVF HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST HEATING & VENT- A/C FIREPLACE ROOF cg _1;1' - BOND BEAM O.K. TO WRAP - — GROUT O 4' O 8' FRAMING INSULATION PRE -ROOF COVER NO WOR DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK ELECTRICAL PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED. TEMP POWER UNTIL ABOVE HAS BEEN SIGNED FINALS ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING l Certificate of Occupancy Cit y of. La Quinta Building and Safety Department This Certificate issued pursuant .to the requirements of Section 109 of thee-Unifoim 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: 79-993 RIVIERA Use Classification: SFD Bldg. Permit No.: 9804-128 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL r Owner of Building: KSL LAND III Building Official Address: 55-920 PGA BLVD City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 8-19-98 POST IN A CONSPICUOUS PLACE