Loading...
9801-040 (SFD)c LICENSED CONTRACTOR DECLARATION �N I. hereby affirm under penalty of perjury that I am licensed under provisions of 1-- = Chapter 9 (commencing with Section 7000) of Division 3 of the Business and C14 W Professionals Code, and my License is in full force and effect. O = License # Lic. Class Exp. Date LLJ 99i oZ r- Date �,' n Signature of Contractor- 41-7k ontractor_ r (o Op J U coo OWNER -BUILDER DECLARATION WWW I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z_ ( ) 1, as owner of the property, ormy 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 co O I am exempt under Section B&P.C. for this reason to N Date Signature of Owner O rn WORKER'S COMPENSATION DECLARATION .o 2, Z'` I hereby 'affirm under penalty of perjury one of the following declarations: T_ .. O, (•) 1 have and will maintain a certificate of consent to self -insure for workers' I';X UJLL compensation, as provided for by Section 3700. of the Labor Code, for the .0 � 4Q"" .performance of the work for which this permit is issued. I' Im Q V) I have and will maintain workers' compensation insurance, as. required by O U Q Section 3700. of the Labor Code, for the performance of, the work for which this LID 11.H permit is issued. My workers' compensation insurance carrier & policy no. are: q1t Z Carrier' Policy No. CIS Z) d ?.1111.041N5. CO.. W% 683896'Me, J (This section need'not be completed if the permit valuation is for 1$100.00 or less). • - O 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' compensafionlprovisions'of SectioR.3700 of<the: Labor y Code, I shall forthwith comply with those provisions. Date: //1 /� Applicant''` ,.• Warning: Failure to secure Workers' Compensation coverage is unlawfu 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 .(Owrier/Agent) _ _ . Lt Y r Date BUILDINGPERMIT PERMIT# CONTROL# DATE1 VALUATION LOT 9801-040 - TRACT 6510 f ! $204.442.70 46. - 25 0-2 JOB SIT 1 APN ADDRESS 80-616 RIVIERA 761-080-073 OWNER CONTRACTOR/DESIGNER/ENGINEER KSv 'LAND '1H KSL DEVELOPMENT CORP 55920 W rA BLVD 35920 PGA BI VD L.A QUINTA CA -0225-1 LA QVINTA CA 92253 {7�ii}fit-?1G6 Y, e CBL# 4676 c' USE OF PERMIT Wr) i3 LOT 46 e YD.ER PLAN 3AR.. ALAN C'ITFf iC FEEREDUCED fVftJuIPI.Es msui ct OF Se§mu PLAN'rYP1r. "• CUSTOM CONST1FtICMON 2.450 00 SF;, 1ttCN/PAT1Ci24s 0i) 5'27.4B d C' ARAC"rFC-MA POWr F; 1{�i:1id1ATteD COST Orr CONSTRUCTION ''. _ 244;42. 1 `.; PERMIT PEE SUMMARY CONS'11RUCTION FU, 101-000-11849110 PL IQN1 CHEC1.1"FU I01-OW439-3.18 '5-205:87 1ksEt^iIAr1lCr�a .1 F1 •101-000-421.41510 25.f_fa ELECT RICAL Fes: 101-000-420-000 S 15379 PI.t:Iil M,140 FEE 101-000419-000 $167:25 4iz©i+tc'1CYf14i 1i - ttislD I01-000-22 11-(10 S20,44 GRADDIG FEE 101-05;(1-423-000 520.00 INF:( A.5i1`Rt I'()PJ FFE 2.'5.000 -*13-342 14,5-26:64 ART IMPtJFAJ( PLACPS -'.RESIN 701-000-255-M10 SUIS -TML CON STRUMONAND PLAN CHYLI $6,454.03 LESS 1':R.is-P1S.1.9:> FEES IW,10 ' "TOTAL PERMIT FEC . M NOW $6,454.05 RECEIPT DATE By / DATE FINALED INSPECTOR f�E ��w INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ile Q Ducts Slab Grade Return Air Steel Combustion Air Roof Deck i Exhaust Fans OX to Wrap —Qf F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewa! Exterior Lath Drywall - Int. Lath Final Final - BLOCKWALL09 APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location ' Underground Electric I' Underground Plbg. Test J,`iFinal Gas Piping r: PLUMBING APPROVALS Gas 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 ? - oZ - Q `T. Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) 0-1 ELECTRICAL APPROVALS Temp. Power Pob Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power -Final NUtility Notice (Peen) COMMENTS: e ,b 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 ol%wing: BUILDING ADDRESS: 80-016 RIVIERA Use Classification: SFD Bldg. Permit No.: 9801-040 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL Owner of Building: KSL LAND III. Building Official Address: 55-920 PGA BLVD. City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 7-8-98 POST IN A CONSPICUOUS PLACE