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9802-106 (SFD)h 'i1 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 L• Exp. Date M Date v" Signature of Contractor AV,✓ 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 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 fo`r�by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. (y) 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: Comer Policy No. -A rl'i 11`4 Yl.SC C+r'+ 1's ceY 06S.1,C"NAV.e, y,lr; • I..1J0\1`.11 1. JeJ. .rw. t".1Y..I'�'S7.9i�.- (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,"Failu comply with those p ovi iaa� Date:Applicant Warnecure WokeJ�,s' Compensation coverage is unlawful and shall subject an employer to crimlt5al 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 C, and State laws relating to the building construction, and hereby authorr4e representatives of this City t4enter the above-mentioned property ffor inspctionpurposes. f /\`r I �ignature (Owner/Agent) Dat-•� PERMIT # CONTROL # BUILDING PERMIT - - DATEt VALUATION S31fi 693.54111 LOT, ti'. TRACT f08 JOB SITE ( J, v ..t . oxw.. . ADDRESS 60-J.10 61, VA lyar%. APN_ ii►lt�iliYll^1i1,9 OWNER CONTRACTOR / DESIGNER / ENGINEER rr �t , 1,b'�th trt !b I , 7+n a/ r .11 � eyr�.t•,t;;bt(.l.t:`I�f�}rt,.sn•r`,(ju�� .. 19J31./ .. �.a 1 A I,.t • .� •a a,;),_c .' iA U."V V" i 3920 S3cm 6, 1,Vi3 ".• 1..A4QtJliu't.A t..t1. 911153 LAQUiNTA `A R53 f7tf)D. +4 +tt`Ki CRI X 4676'; k USE OF PERMIT 41 �i1�'J 3.:411 . 6 PL ��I3 �i3 1� $alJl;rsi �.t1L H3�f r f.t.i�, 4'i fa tj!`3yL�P�L3 F a 6N. j 1 f 1 t t1998 1'YkfE'� ✓ 1'- c 1i11!?r�tfhJC:N43'ta;fd't' Off "Pel. ITL Quill N R .. r. y L ^§'&(a,y " •;(:• \ !•� a �• i►Q��. /y'♦•S'OFG�.•Y" y� C11 ON II SSY 0.4 L EF .a',�a p...�ar• i fs:. '1..I,lC'11.! l.�tJ n.,• i a4�iV ita£b � �11��0,a 7 A�51 f• z C'0*Nf r°f 14th Ff0 t•3 FEE 101-000-4114-4106 pi:4Af C!H;lkl F't i 4l l -!3fKi 3�/ aIIEC' OTANNI`:A�.1 1-Ti.ili-a�i�k'�tii^ }ij �} wi�4.5(. Yap +:n.i, a1. .. w" ' �fS�.iS1.M`f`1iil.�t�Ir.f:• ✓. �4, dt3'•4��{1 • S22%1.68 4�LU�lf3lt�ftdr��f; fl"1#--SJDti-•'1`i'�•�H}(1 5251;:4? . 'F!??'t`q)��a�fa6`r��ryAlh":;`ir'.tCIV FfT,' - FG' 110A01 -W -2 l ..fFlNrNt7I ^,arid-•f3i) Ili .9 tJll it i:I�,t'�.1.,jNA 1,ISl'.!:!.: .d.U3. •ilVti' 1:'iJ- T`i✓ d.D,� .t+�' 11 '1" IN I?C.131AC14N4:Y S ,'21:.S1 ' _101- )Cff ,255-4ii)(3 f t IA (:^fra C'.R ;C1,'i"sc IN A N. ra'p1,,ktq; a pC,,€ t8,8179 341 LESS PRP -17 FEES S01911 -AID �p i-;':i,i3iVb` FE, EN i3�94;,i�C1W RECEIPT DATE BY ` / DATE FINALED INSPECTOR i liv INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs CA Underground Ducts Forms & Footings • J Ducts Slab Grade Return Air Steel Combustion Air Roof Deck - -Lt g Exhaust Fans O.K. to Wrap _ -9K F.A.U. Framing n, 1- Compressor Insulation IF .7 e Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulatibn Condensate Lines Party Wall Firewall Exterior Lath - ( _C1_ Drywall -Int. Lath (o=(- _ 99 Final Final d ` - — POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs a 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 3 - 9 _ Heater Final Mater 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 COMMENTS: Final Utility Notice (Gass 7- .2/ ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wirir g , Fixtures Main Service Sub Panels Exterior Receptaces G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm)-`�� 6 Certificate of.0ccupancy City of L.a 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: 80-176 RIVIERA Use Classification: SFD Bldg. Permit No.: 9802-106 Occupancy Group: R 3 Type of. Construction: VN Land Use Zone: RL Owner of Building: KSL LAND III Address: 55-920 PGA BLVD City: LA QUINTA, CA 92253 Building Official By: STEVE TRAXEL Date: 9-29-98 POST IN A CONSPICUOUS PLACE