9802-092 (SFD)LICENSED CONTRACTOR DECLARATION
?� I hereby affirm under penalty of perjury thad am licensed under provisions of ,
Chapter 9.(commencing with Section 7000),of Divisl6, of the Business and'''
Professionals Code, and my License is in full force and'effect.
License # Lic. Class Exp. Date ,
734283 30,; 1i'4,
,/Date Signatureof`Contractor
OWNER -BUILDER DECLAR ION
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 ofatHe 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:
(c ) I have and will maintainia 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.
r,T3i<tC.IY li : CO WC 6=1 96506
(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 Californih, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shdllfo hwith comply with, those-
' pf�y`sions.
{/Date:�Applicant 7
V
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, indemnity
& 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-
2i
above-mentioned property for19spection purposes.
Signature (Owner/Agent)Kj �� Date
rAll V
_
r, I" PERMIT# ir. •CONTROL#
FBlJ1 DING -PERMIT � .
DATE fi •f 1 ""VALUATION LOT TRACT
JOB SITE'
T APN
ADDRESS r M) :� 37 $s6�•'�• RA
OWNER CONTRACTOR / DESIGNER / ENGINEER F
-55920 Ps"iA.c37• VID 3-5920 tPt:rf1.13.L.1ID <
A. Q)UN' A. CA,. 9225 i LA QUINT. �, � r%CA. 42233
(76q)S6,4 71 CB .' J, 4fi•hi
USE OF PERMIT
? r FE8 2 x.1998
OF L
CUaT�ibi'v01�1��`retG"iT:td 3,308.00 {tt±
!'(7RCkll!'r1 f.s "t 364.00 '3F
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CC) NST1Z:(JC'"f10N.FEE tOI.-COU-418-CUED
PLAN C7 FF93
WC1IANICAIL,FE13
UKI'VOCAI FEe, 101r000-420-000 M).82
€�1.CliL1f31L30T-E 10:1 4117(D�d1-(3CtLt 21:x.2
ti'd'RONG MOTj!ON ITS - RESID 101 -MO -244-O
GRAVA'NO P01 101-000-42MOO =00
1�JF ' AS '12iJCTIJ'F FS ME 225-000-4,0-34.�a:t3CiiD t�
ART IN PUBLIC PLACES -. M8TC `71ST -0W-255-001
C)I?1=T't71'ACt GONS":'KL1C 1:1ON A�3.4 } B'J� ��3 � 1:1 F't~K �� Aga •$6
LESS PE -PAID FUS . $CaOC
RECEIPT DATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings i
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
_ Q
Exhaust Fans
O.K. to Wrap
_99
F.A.U.
Framing_
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
'
3-a3- d -
Final
Final h - — _
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
-
Heater Final
Water Piping
Plumbing Final
Plumbing Top OU
Equipment Enclosure
Shower Pans -
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
X
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
FinalUtility
Notice (Ga -3)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiri-ig
Fixtures
Main Service -
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Paver
Final
Utility Notice (Pe m)
Certificate of Occupancy
City of La Quinta
Buil.ding.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: R 3
Owner of'Building: KSL LAND III
Type of Construction:
v
Building Official
80-137 RIVIERA
Bldg. Permit No.: 9802-092
VN Land Use Zone: RL
Address:
55-920 PGA BLVD.
City:
LA QUINTA, CA 92253
By:
STEVE TRAXEL
Date:
10-26-98
POST IN A CONSPICUOUS PLACE