9803-034 (SFD)LICENSED CONTRACTOR DECLARATION
I he4eby 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
Date* t t ,I ��.i SSignature of Contractor' », 1
rt i : 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: `'•-" r
( ) 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 Sianature 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 forty Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
() ['have and will maintain workers' compensation insurance, as required by
Sedtion 3700 of the Labor Code, for the performahce of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
WRIal WS, CO. l WC 1+t§:;s9 06
(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 manneroso as to become subject to the
workers' compensation laws of California, and agree that if I should become'✓
subject tolthe workers' compensation provisions of Section 3700 of the Labor
Code; shall forthwith comply with, hose provisions.
/Date:«. f '•F��i i. Applicant 1 ►,
Y 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.
4
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
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 property for inspectionfpu,'rposes. )
/ d
vSignature (Owner/Agent) f I f� Date
t
PERMIT#' CONTROL#
PERMIT
:,BUILDING
DATEr• J«.TRACTVALUATION LOT- �&A S 2
.;
ADDRESS f 6 -:L83 Rii�� IERA
APN •. 61-0 1&073
OWNER
..
CONTRACTOR / DESIGNER / ENGINEER
t\SL LJ'i,4' O Ili :` - •
'.i.e3L.bi» erd:MaJnm.VT.i, li.\±i' t•+ n
•
55920 PGA cif>VD
56 140 PGA.8I..Yi�
- ' 93"
LAe;)U7�"� t� . • ><;� :53. •
[,E1(�U'IIV'I'!� CA 92,2153 �s
�1G0) ri4-7i.ts5C fT4F 4670
USE OF PERMIT
_
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�
1.OT 29 X71 A. i I PUQ4 2A-041: PERMIT DOES NOT .t[ZCLUM 19.6CK
WALLS OR .t'1l•)01— w PAID I
31 � .�•
j Qc a
Oct a iO CITY
OF L.A QU•INTA
a,MtACTLYCARPORT 67 7. 00 Sr-
�•. F i - -
k" Ail y 4i�•
' 1t'r.lTASY.9AAED COST OF CONSIIRV�4�'4.��J"t it
27..aVii
CONST 1tIJ�:'Y'[S�t�f,t .C, t. `?5.
PLIVNI �:� f 1-t?cf�-�43�} !R 3 4 11,422,29
t'�sCktAd'iPt Af'.6 F;�? tfits�i) (? f-a�1U k MAO
Ll C'il�fr'F1t; Fes'. 1011-000.420-0) $i4t6.£S1
�'LLiR 3Y�IC 1.01-000-419•(X)0
8 t'.ttf`i:NG MCYCION RM - Ir -,M) 'Wk -000-2,41 -0)
ORAI)rNO FtS. 10:1-t7i 04D-000 s.2A.00
JNFR S6,!) ).00
ART f.N t'UBLIC YL.AC S ^ 'RESIL 101-f 2554JO $439.5 1
til'-1"t�C!t��ITtTtri`:Ctr%.AN)>t..AN t"HCK. `
$962i.?�
L,:1""S. 1�1tF-i?AIL� f 1;1 5
._
_ $0.00
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iD:7i �iQirL:fNCD
f 1
RECEIPT
DATEBY
DATE FINALED
INSPECTOR
f Ott
Q'w
y
I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION j
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs d
Underground Ducts
Forms & Footings ,
Ducts
Slab Grade I'r
Return Air
Steel It
•Combustion Air
Roof Deck i —
Exhaust Fans
0. K. to Wrap i' 7—
F.A.U.
Framing "
Compressor
Insulation i
Vents
Fireplace P.L. 11
Grills
Fireplace T.O. I!
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath It y oZ
Drywall - Int. Lath
I.
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs I
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
!`
Equipment Location
11
Underground Electric
ii
Underground Plbg. Test
Final 1'
Gas Piping
I� HPLUMBING APPROVALS
+�
Gas Test
Electric Final
Waste Lines I;
Heater Final
_
Water Piping I;
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
Final !; _
Utility Notice (Gas)
j
ELECTRICAll 40ROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring ]
Low Voltage Wiring
Fixtures ];
Main Service I
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
C
Final
Utility Notice (Perm)
COMMENTS:
'
Certificate of Occupancy
City of La QU'inta
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: 80-288 RIVIERA
Use Classification: SFD Bldg. Permit No.: 9803-034
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND III
Building Official
Address: 55-920 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 12-3-98
POST IN A CONSPICUOUS PLACE