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.
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(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_
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OWNER
CONTRACTOR / DESIGNER / ENGINEER
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LAQUiNTA `A R53
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USE OF PERMIT
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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