9802-103 (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
/- (Laa ✓ 1 'hb
ai ` / Signature of Contractor•
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.0 -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 arid 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 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. .,
6��i\jf�lt. 3A l,`{'.�'•Y, t'1 .:=.. 56+1 •t''cc i'll r.
} t f � � I. Y}+.. (. F!_.y-"{).,.•661./
(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 manne�rso as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation•`�provsiohs+of Section 3700 of the Labor
bode, I shall forthwith comply withrthI pPouisi ��'�
✓Date' 1 4 VIY Applicant/ 1 ✓ 4 -
Warrnng: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,. iri
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 �.Gity, and State laws relating to the building
construction, and hereby autshorize representatives of this City to enter upon
t � above-mentioned prope • for`inspection purposes.
Signature (Owner/Agent) 17 Dat
PERMIT# CONTROL#
- - ' - • BUILDING PERMIT
' 9H,_103
DATE ` VALUATION q, LOT TRACT
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JOB SITS
APN
ADDRESS r"4 -U-.2,24 W!'.1iUttt<
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OWNER
CONTRACTOR/DESIGNER/ENGINEER
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USE OF PERMIT
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RECEIPT • j
DATE
BY
DATE FINALED .
INSPECTOR
~- INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
'� J
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-/ c3�
Exhaust Fans
O.K to Wrap
6=1_,Z- q7
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
_yk
Drywall -Int. lath
17
Final
Final
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
3-f
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
3=/3 =Q� ��.
Pool Cover
Encapsulation
Gas Piping
_ Gas Test—
Appliances
Final
COMMENTS:
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
r
..
Final
Utility Notice (Perm)
_
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 regulating building construction or use. For the following:
s
BUILDING ADDRESS: 80-224 RIVIERA
Use Classification: SFD Bldg. Permit No.: 9802-103
Occupancy Group: R 3 Type of Construction: VN. Land Use Zone: RL
11-
Owner
1Owner of Building: KSL LAND III
Building Official Cl
Address: 55-920 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 11-9-98.
POST IN A CONSPICUOUS PLACE
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