9801-046 (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
��Z�'
Date r; Signature of Contractor r
OWNER -BUILDER DECLARATION v
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.
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
e permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
ZURICH IN3. CO. WC 683896M16
t -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' compensation provisions of Secfio 3700 of the Labor
Code, I shall'forthwat comply with those provisio s
Date: • Applicant
Warning: Failure to secure Workers' Compensation coverage 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, and State laws relating to the building
construction, and hereby -authorize representatives of this City to enter upon
the above-mentioned prope/rtyy 0)inspec�tio{n purposes. ru poses.
Signature (Owner/Agent)
f f
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT 0801.-046 TRACT4
/13 $336,413.20 11
JOB SITS
APN
ADDRESS 80-017 MfErRA,
761-4180-03.1
OWNER
CONTRACTOR / DESIGNER / ENGINEER
l .SL LAND III
"KS1, DEVELOP&IENT CORP
X5920 POA ;BLVD
5.920 PGA B1.101)
I,AQUINTA CA 92253
LA-QLf.IN1A. CA. 92253
� fOjS64-'71e�6 CBL i 4076
USE OF PERMIT°
LO i 4, HERITAGE PLAN 3DR-0,3. PLAN CRECK 1 S RET)UG`L"D 75%T -OR'
MfULT:03LE ISSUANCE OF SWE PLAN'I'1`PI3;
JAN
8 1998
CUSTOM CONSTRUCTION. 4,04.7.00 SF'
'PORCIWA`I`IO 19100 SF
OF
llNTA
GAIaAQWCA",09T n7J.* saGIiY
ESTIMATED COST, OF CONSTRUCTION
.336,41120
PERMIT FEE SUMMARY
C0NS'I'RLX f:(ON FEE 1.014000-418.000 $3,469.00
PLAN CHECKT'EE $303.57
MECHANICAL EEE 101-000=4214000 $162.50
RL -J CTFUCAL FEE 10.1-000-420-000 121169
PLUNIBING FEF 101 -(JOU -4.19.000 $260.50
STRONG AiarION FEE - RES O 101-000-241.-000 $33.64
CRAWNG.FEE 101-000-42MOO 5.20.00
1 y,,RAmUC'1`URE FEE 225.000-443-312 $6,000.131)
AW- 1N PUBLIC.PLACI,S RISA; 701-1300-255-000 $591.03
SUI�TOTAL CON STRUC'1'10'N AND PLAN CHECK
$9,072.93
" LESS PI -PAID FEES
$0.010'
TOTAL PERMIT FEES DITE NOW
$9,072.93
RECEIPT
DATE
BY '
DATE FINALED
INSPECTOR
14
INSPECTION RECORD
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
- .30
Exhaust Fans
O.K. to Wrap
9
F.A.U.
Framing
— (( -- g -
Compressor
Insulation
—II&_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
^ -a?_ Q
Drywall - Int. Lath
Final
Final I If - y • Iff
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
,Z -
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-a _C1
Encapsulation
Gas Piping
Gas Test
Z
Appliances
Final
Final
Utility Notice (Gas) -
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Futures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Po %vr
Final
Utility Notice (Perm)
COMMENTS:
Certificate -of Occupancy
City of La: Quinta
Building and Sa.fety 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 compfiance with the various ordinances
of the City regulating building construction -or use. For the following:
BUILDING ADDRESS: 80-017 RIVIERA
.Use Classification: SFD Bldg. Permit No:: 9801-046
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND III Address: 55-920 PGA BLVD.
Building �,Official
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 9-9-98
POST IN A CONSPICUOUS PLACE