9801-052 (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
OWNER -BUILDER DECLARATION f. ,
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).
( ) .1, 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
pe ormance 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:
Carter Policy No.
ZURWH INS, CO. QVC 683896506
'fir(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;
Ishall 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' compensa ltlt on,provisions of Section 3700 of the Labor
Code, I shall fo with comply with hose rov slo S.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is uni ful 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/Agent) %� + ate i05
'BUILDING PERMIT PERMIT# CON��TI1ROL#////qqqq /�
DATE J/)y VALUATION LOT 10 9801,052 TRACT K :
JOB SITE 1 APN
ADDRESS 811-:121. RI VIE%k 761-496-031
OWNER CONTRACTOR / DESIGNER / ENGINEER
KSLLAND III 1SL.O'EVELOPMENT CORP
;55920 PGA BLVD 3:5920 PGA BLVD
LA QUIWA CA 96253 LA QUtb t CA. 92253
(?L�U)541m71Go C&L" ,4.6711 .
USE OF PERMIT
LOT 10. +MF 1TACfP Ia1.AN 3C;-132. PLAN OV1 CK FUS :itWOCFI) 7.9%FOR
� �
A4ULT1PL£ ISSUANCE OF S AN F ..PLAN TY M
JINN 0 8 1998
CUSTOM C NS CR[3C--TON 3,894.00 SF
PQR0V?..kT1C0 �CITY F U QUINT'S
GARAOWCARPORT 727.00 Si^
CS.Tl.ltIN ED C''AS'.C' OF CONST9ti '. oN
FERAIRT ,EEE SC311iiiiARY
CONS'IRCI rION1'11113
101-0110A18-tifitD
t1,427.00
PLAN C-W!K FM,
10:1.0013-=139-318
52912. i3
MECHANICAL FEE
513030
ELECTRICAL _3 fM
10i _000-4204k0
$2N,33
'PLUMBING MRs
101=I1U _119-0A0
$253.25
S511RONG MCY110N kU. - RM0
101-000-241.-004
,, &32.45
GRADING FEE
101.-000-423-000
r
$20.0
WFRA,STRUC'I'UR N.fsds3
225-400-443-342
$6;0()0,00
ART 114 Pf BLI[C PLACES - R7 STI
701-(100-21`5.-000
.556LZ4
SUB -TO' AL CONSTRUCT`iON AND PLAN CHECK
LESS PRL -PAID FEES
I
324,4 . t.5i1 i
M,024-85
50.19)
'tOT,AL PE MI'T FE E8 DUE NOW I 58,924:85
RECEIPT I DATE I BY ! I DATE FINALED
INSPECTOR
Val
4r
NSPECTION • RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
,BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 5Underground
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck �} — 3 0 - �,
Exhaust Fans
O.K. to Wrap . Q
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath —k
Drywall - Int. Lath �(
i
Final
Final — —
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
6. 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 S
Encapsulation
Gas Piping
Gas Test . / 7- - Tv
Appliances
Final
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
• T
Final tl
Utility Notice (Perm)
COMMENTS:
i.)
Certificate of Occu'pancy
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:
Use Classification: SFD
Occupancy Group: R3
Owner of. Building: KSL LAND III
80-121 RIVIERA
Type of Construction: -VN
-Official
Bldg. Permit No.: 9801-052
Land Use Zone: RL
Address: 55-920 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 9-23-98
POST IN A CONSPICUOUS PLACE