9801-049 (SFD)LICENSED CONTRACTOR DECLARATION
I hfmby 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 I/
Date Signature of Contractor_ ' i. J'
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
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.
WC3 633896W
(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 Section' 3700 of the Labor
Code,yshaort with comply with those rovisions.Date: ApplicantWarnilure to secure Workers' Compensation coverage is unlawf I and
shall subject an employer to criminal penalties and civil fines up to $1.60;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 permitissued 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/Agent) ate
BUILDING PERMIT PERMIT# � CONTROL'#
9801-049
®
S
DATE / VALUATION $24.1 S 1.9.20 LOT 7 TRACT Ji
t
rt
JOB SITE
JOB
ADDRESS 80-057.>1tTAERA
APN
761-480-1031
OWNER CONTRACTOR/DESIGNER/ENGINEER
KSL LAND 111. KSL DEW..LOPMWF.CORP
5591011CYA BLVD 55920 PQA BLVD
LA QUINTA CA 92253 LA r IJWIA CA 92253
USE OF PERMIT -
SF0
LCAT 7JA5,dT AGfs Pl AW 211 P .
JAN 0 81998
C "r10iV z, t 00 5 CIT' ®
�z ��? T
ST01 C C31N5'i'i2UC
POl2CtifPA'i ICS 340`
1
GARAGVCARPORT 677.00 $F
t
&NITAVISM) COST OF CONSTRUM ON
2411,839.20
PERAHT 13 EE .SU1VIN A Y
CON:STRU t`ION FRE 101-000-41911100 111116.50
PLA14 CHECK "FEE 101-000-439-3.18 $92.1.6
MECHANICAL HE .101-000-421-000 $85.50
P-1ECTRICAL fIE8 10.1-000-420-000 $171.56
PLIA[BING FM.z 101-000-41.9-000 $179.25
STRONCt MOTION FEE -.REBID 101-000-241-000 $24.18
GRrVANG FEE 101-000-423-000 $20,00
1NFR.A31`ItWTtl" h.E� 225-00044-3142 S5,132A15
ARS' 1N P'tJOLIC PLACES - RESM `:01-000-253-000 $354.60
SUB--I'C)IML CONSTRUC110N AND PLAN CH CK
$13,225.73
LI -78 .PR1 -PAH) Ki ES
$0.130
W0'/, L PERMIT FE ES DUE NOW
SS,,%ZS.73
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_�
Underground Ducts
Forms & Footings10
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
— _41
F.A.U.
Framing
_ Q
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
Final
Final
POOLS - SPAS
BLOCKWALL
_
APPROVALS
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
„2 —I o
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— 7 ;L
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
goQe- R,14M o K,
-.0 -f j-
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 v.-7//
Utility Notice (Perm) �Le� YX
y
Certificate of.Occupiancy
City of.La Qu'inta
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: 80-057 RIVIERA
Use Classification:
Occupancy Group:
SFD Bldg. Permit No.: 9801-049
R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND III Address
Building Official
City:
By:
Date:
POST IN A CONSPICUOUS PLACE
55-920 PGA BLVD.
LA QUINTA, CA 92253
STEVE TRAXEL
9-11-98