9802-100 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury n
that I am licesed under provisions of r
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 rr Exp: Date
734283 � � �S r• � Z� }It9ei
ate "),12 L ignature of Contracto
ffW
OWN ER-BUILDER-DECLARPATION
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). `
O I am exempt under Section B&P.C: for this reason t- ,
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
S.dhon 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.
.c` RICIN 'JIKS. CO.
(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 CalifoTia' and agree that if I should become
subject to the workers' ,compensatiorr'pro6sions of Section 3700 of the Labor
Code, I shall fortl4with4omply withthose ppiovlsio 's.
Date; t ; I'&Applicant � �`� <�V�'�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penaliies 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 City, and State laws gelating to the building
construction, and hereby author ze r`epresentatives of this City to enter upon
the above-mentioned property, for inspection purposes.
i
gnature (Owner/Aoent) Date.,,
Y o f • �' ' PERMIT# CONTROL#
UILDING PERMIT =a to {
> q $2" 7 t
DATE �1' z 2 VALUATION r + LOT TRACT (��-8.7
JOB S�� 0
ADDRESSITE i. F^b7.�r2 if"RA
APN �1) ,* V'cTa1
OWNER- j
'q�
CONTRACTOR / DESIGNER / ENGINEER ! k
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I t
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pp D y
Fp St. EAMLOPKIVNIT
5910110 BIND
r�
55` 20 k?�"A BLVD
"I,A
1AfN"iii , �' : CA. 92253
C3�[,-y�,tNTA CA 32253
USE OF PERMIT
4WD
816 LOTj)'1;1,.A414 0.2 RE, PLANT 01WIc:� FEE APPLIED
FEB .2' 1998
CUISMOit+t Cd?iNS i:Ur—'VIt' N 3,091000..SJIT'
L rlPtnf :#lC.tlYtl'c alt t' 713.00 3t
$ F
rnmmna, cams
�'�akti' 'I�i{C''IO i 4 sw1s 1 10.1 -I}00 -4i&-000
fNCHEM �? �301410M19-318 $244.46'
v.4ACtrE81.50
'
CLr-,0'A1CAL .FE 6 U79.95
PL(Ita138lA o r.EE;01-000-419-q, )0
8'170'14 MOTION FM:1Mq19, 100-0f➢i➢-2'41-000
GRADING .k EE: 101-000-423-000
INFRA.' 1R1Je'W11E FFAl Zig-0*-34$ ssina.18
AKr IN PUBLIC KACII.'S- .[tE.'�1F; '7f11-V)0T25f-000 $13 95
LPI -' t"sTl;, tW�>:N'S'f,.t i�tCq'i.UN n It PLAN CHECK
,10�a,17 =
LS'PRE-PAID F MS
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RECEIPT
DATE
BY f
DATE FINALED -
INSPECTOR
_1
.4c
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
A
Combustion Air
Roof Deck
2 _
Exhaust Fans
O.K. to Wrap
_ _Va T,
F.A.U.
Framing
— _Qd/
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
Final
Final
o z —
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.
— 7 —Q
Heater Final
:Water Piping
Plumbing Final
• Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection•
-l7 ,
Encapsulation
Gas Piping
Gas Test
T L
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
f ,
Final j� f
Utility Notice (Perini
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:
BUILDING ADDRESS:.
Use Classification: SFD
Occupancy Group: R 3
Owner of Building: KSL LAND III
80-272 RIVIERA
Type of -Construction: VN
Building Official .
Bldg. Permit No.: 9802-100
Land Use Zone: RL
Address:
55-920 PGA BLVD
City:
LA QUINTA, CA 92253
By:
STEVE TRAXEL
Date:
10-12-98
POST IN A CONSPICUOUS PLACE