9802-096 (SFD)LICENSED CONTRACTOR DECLARATION
I,hereby affirm under penalty of perjury that I am licensed under provisions of`
Chapter 9 (commencing with Section 7000).*'f Division 3 of the Business and'
Professionals Code, and. my License is in full force and effect.
License # Lic. Class Exp. Date ,
714.283 4
Date - 9 „Signature of Conor l
r` ( f
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 riot intended or offered for
sale (Sec. 7044, Business & Professionals Code). . ,
( ) I, as owner bf 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 3700.0f 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, ;
n1dClA, INNS. CC), VVIC 40-1.196506
(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 �d agree that if I should become
subject to the workers' compensation'provisions of Section 3700 of the -Labor
Geode, I shl(l forthwith comply with 6bse`provisii ns.
f Date: a' L : I " J Applicant
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 behalf1this 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, itsofficers, 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 propertyN.f6r iinsl6ecctioonn purposes.
Sgnature (Owner/Agent) Date,==Jl
s ��.;E -BUILDING PERMIT PERMIT;CONTROL#, r
DATE s VALUATION y-2 ,r 1 34 LOT 5 TRACT, +' y "'&864
r _14 c
ADDRESS 80-201 1!'�.ei11 ..
AP ` 7li.�,= 0-0.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
K Wit,
KSi.1111`�rzs�{,;t�F''�.A�! ":lolltp
. SPA ti l-! T.s� 1J :. ... -.
- 5.>j"�tF C\.6,�' !:1Ir V D
LA QUMA Cit. 92753
opt.A CA 9215:;
(70)150-7166BUI 46,76
-
USE OF PERMIT
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;off, 2�3p.�5�t
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FEES
YOTAL PERMIT FEES"(PIE NOW
RECEIPT
DATE
BY ( : '
DATE FINAL ED
INSPECTOR'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms 8 Footings
O
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_2 -Q
Exhaust Fans
O.K to Wrap
qIV _
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
/ -
Pr �J25
Final 6- oZ�
ELOCKWALL APPROVALS
Final
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.
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top OtE
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
p ,(y .- Q
Appliances
Final
Final s�
Utility Notice (Gad)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wir[ig
Fixtures
Main Service
Sub Panels
Exterior Receptacles .
G.F.I.
Smoke Detector:
Temp. Use of Power
c
Final (%
Utility Notice (Pe -m)
COMMENTS:
Certificate of Occupancy
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 regu/ating`bui/ding construction or use. For the'following:
BUILDING ADDRESS:
Use Classification: SFD'
Occupancy Group: R 3
Owner of Building: KSL LAND III
Type of Construction:
..< a •' �..�
Building Official
80-201 RIVIERA
Bldg. Permit No.: 9802-096
VN Land Use Zone: RL
Address:
55-920 PGA BLVD
City:
LA QUINTA, . CA 92253
By:
STEVE TRAXEL
Date:
10-22-98
POST IN A CONSPICUOUS PLACE