9801-047 (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�^'/�i31/9
Date i , �ignature of Contractorw.,t 1 i/ A 1- !�
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 I Sianature 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.
ZukICfi INS, Co. WC 6SM96506
(This section need not be completed if the permit valuation'is for $100.00 orless).
() I certify that in the performance of the work for which this permit is issued,
I shall not employ any personin 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 Se t' 3700 of the Labor
Code, I shag fortwith comply with thoseTprovisions.
Date: f r0 Applicant 12 1# 1- �—
Warning: Failure to secure Workers'. Compensation coverage is unla u-1 and
shall subject an employer to criminal penalties and civil fines up to $100000; 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.l 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) :/ Datel
BUILDINGPERMIT PERMIT#
c°NTRDL"':
"01-047
6 5 8
DATE VALUATION LOT TRACT .,
SF24,815.90 213 111,'
"
t ,,
JOB SIT y
ADDRESS 90425 RIVIE�l
APN
761-4901-031
OWNER
CONTRACTOR/DESIGNER/ENGINEER
-
I:SL LAND III
I .SL, DEVELOPMENT CORP
35920 PGA BLVD
55920 PGA. BLVD
LA QUINTA C -A, 92253
LA. QUINTA•
CA 92253
(7'60)56,1-7166
CR- 0 4616
USE OF PERMIT
5}
LOT 5.:BERITA013 PLAN 13.
CUSTOM CONSTRUCTTON 2,0&010 SF C, $ 1 6f v e
Eet�i ��D� i tlTA.
PORC-` -PAT10 302,011 sh
CAR.A.MI CARPORT 7:13.00
LSTIMATED COSI' OF CONS T1tL:C'l'Y(3N
224,89 961
PERMIT FEE 3lTM1 ARA
CONSTRUCTION FFX 10.1-000-418-000 $1,077,00
PLAN CIECK FEE • 10.1-000-139-315 $877.
MECHANICAL FEE 101-1100-121-000 579.00
EL FCCRIGAf.:>"RF 101.-000-420-000 $164.69
PUMIDING FE 101-000-119-000 $.185.?5
STRONG MOTION FFA - REV) 101-000-241-000 S".48
GRADTNG FEE 1.01-000.4,13-0001 $2tt.ft0
1:NFk,A MRUC:'ftTRR FEE 225.000-443-342 $4,967.98
ART IN PUBLIC PLACES - RESIr, 701-000.255-000 $312.04
SUIS !WAL CONV fRUCfION ANL+ PLAN CHECK
$7,705.73
LESS-PRE-PAWEES
to.w
TOT -Al, Pr.1 Rh1riT PuES DUE NOW
$7,705.73
RECEIPT
DATE
BY / - °
DATE FINALED
INSPECTOR
r.
r INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
fi
Underground Ducts
Forms & FootingsDucts
I
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
.r Q
Compressor
Insulation
_ Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
FinalPOOLS
BLOCKWALL AP ROVALS
-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
""^a -
Encapsulation
Gas Piping
_Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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) :;"
Certificate oT0c.cupan'cy*
�bg
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 at,
building construction or use. For the following:
BUILDING ADDRESS: 80-025.RIVIERA
Use Classification: SFD Bldg. Permit No.: 9801-047
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: 9-22-98
POST IN A CONSPICUOUS PLACE