9801-038 (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
Date Signature of Contractor
—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 . Signature of Owner
r
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
pormance of the work for which this permit is issued.
l 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.
tv.+URIC71-a 11418. CO,
,VC Ob'31396506
(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' comp nsation� provisions of�Section 3700 of the Labor
Code, I s all f • rt with comply with those p,�ro-vl�'Is. )__
Date: Applicant +'
Warning: allure 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 property for'inspection purposes) ,
Signature (Owner/AgenfiPdJ'
,r'/ , DateI ?�L/
PERMIT# °°NTRo
BUILDING PERMITt:,,a;
Y
DATE
VALUATION �i�� LOT Q . TRACTJOB
SIT9
ADDRESS ' 811_• US WI1WURIt
�APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
E;SI. *L�Ii3 l:13
last:, it X1T.; i�:i1�:?iV�'O1uu ...
LA (A![N`.i :fi CA. 92253
t.r1Q1MN'1" A. CA. 92253
( btl�Ssi4-7Ifx5 1x . n6-76- i
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USE OF PERMIT
Ct�'T Via, .1;:'rf.�""1, A•'i.Ei3�i 21�i2.' � �;
C'USTOIIM CONSTRUCTION 2.379 00 3F
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200.201. '.
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1:'[,AN CHECK FHE 1�J1-t300-43�-3:111' $hl.�i,'1✓i
CONSTRUCTION 4:TION r E , J01400 -411".(K) S9191.0
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I3s0 [,11�f.1CAL 1- -� 101-000-421-000
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i�l tIT�R�t7�IL3 101-000-419-000 $t73.Z
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Ni -i11 AST Rl"1`i UWE FFE r 225-000-410..342 $4'.444.09
AR`F lN.f"�L11; mic,' 1;dt�Cls"S - kc:C: qE 701-000-255-000 . 25n.5ii
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JX S IFIRE-PiUDYL I&
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TAYFALTERMI 41 �S DUE NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
c3 — ► �1►�J
Exhaust Fans
O.K. to Wrap
_, �-, _��
F.A.U.
Framing
_3/_
Compressor
Insulation — —Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
-
Exterior Lath
Drywall - Int. Lath
Final
Final -l7 -��—
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
I
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final _
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pols
Underground Coriduif
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptaches
G.F.I.
Smoke Detectors
Temp. Use of Power
t
Final
Utility Notice (Perm)
COMMENTS:
6:�nM
I
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 ADDRESS: 80-048 RIVIERA
Use Classification: SFD Bldg. Permit No.: 9801-038
Occupancy Group: R 3 Type of Construction: VN
Owner of Building: KSL LAND III
Building Official
Land Use Zone: RL
Address: 55-920 PGA BLVD.
City:. LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 7-17-98
POST IN A CONSPICUOUS PLACE