9803-024 (SFD),LICENSED CONTRACTOR DECLARATION.-
I hereby affirm under penalty of perjury that l 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
1347833, f .- r� /31199
VDate; Signature of Contractor,
OWNER -BUILDER DECL RATION i
I hereby affirm under penalty of perjury that I amexempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wagesastheir sole T
compensation, will do the work, and the structure isnot intended or offered for
sale (Sec. 7044, Business & Professionals Code). e
( ) I, as owneYfof 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
r /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 ofIthe work for which this permit is issued.
( ) • I-have•and will maintain workers' compensation insurance, as required by
S ction 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. ,.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that irrthe 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
¢ode, I shall forthwith comply with those provisions. .
,/Date -= /i 'i L4 rApplicant"tI
Warning: Failure to secure `Workers' 'Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation,`damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person uponwhose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La•Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the'above-mentioned property for inspection purposes.' ;'i' .•
i",v/ -,� / 4 i
gSlgnature (Owner/Agent- � Date
PERMIT #.. - -+•
CONTROL#
PERMIT., b
;; �r3i►3-13 _.. r . • y ,.
'
s
BATE 4N, VALUATION - LOT • 19TRACTJOB
SIT
ADDRESS `1�C%/Va�A
APN y 761-4.���
OWNER a
CONTRACTOR / DESIGNER / ENGINEER 4 .
•T'.�' �;}SND iTT `
'K:"! niJ�'�T..L.�94iV�f?T+ITff ',C..C.�t?�'
.
�,92o'T•°CA at. -Vo
f .
56 140.Pt,JA BLVD
CA. 42353
LA.(�faTi�trA CA. �rzl203
r
f;�GA}Sf-�t-71.f•fi '4'�1 # 46 76
USE OF PERMIT
S F D
}'
3
LOT IFI, KRITAO . FLAW Z T:�.T"RMIT WES WT .r�t`L
V N:.I.S OR POOL._ r
PA,IQ + r
MAR
X998
CU.9.AONt,Y..ON:s.t.t3,Ui,T1Vt4 ..,RiL:tSi? SF
PORCH/PATIO 364.00 S,.' d .
QuI�A
GARA. WC:ATWORT 67 .djEi Vit' �� >> T OF
PERMIT ME S[JM1WWV
CONSTR rC "T iia 4 NCH 1011-01004W-000
t~=000
MAN 0tf%+;^T, F; ?()1-()[) 31-439_31 8
%r
'N f.111. "�i1CA1.1.1M 101-000-42 1 AGM
ELECTRICAL 97.t%u.AL FEE 101-diiff3420J" 317$..56
✓y
PLUNIT4lNU FI -111 _ 141-400-419-000
S'e•'RONC. MOMNFFIV. XRIC f :r j01.410 -241 -ft)
Gl"AI i)`1£i
T FI'fZtiS'1.`12Uti: f r3i22 FEE 2211 iO it? -443-34Z $5.332.46
AWI' 1N K.1f31;,Ii .PL..AWT,8 - R 381!; 101-000-255-(300
SUB -IMA -1, C;fJNSOMUCTION M;r) PLAN?
LESS AETA,T1,7:REESS
S��.itf7
y�
RECEIPT ,
DATE
BY./
DATE FINALED
INSPECTOR
`s INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
—
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— —Exhaust
Fans
O.K to Wrap
-ate
F.A.U.
Framing
Compressor
Insulation
— i..( _(Z W
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
02
Final
Final FT7::-2 - -
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping .
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
q�f
/ �`�
Heater Final
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)
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,
I
_Final _
Wilily Notice (Perm)
COMMENTS:
t
Certificate of Occupancy
City of La Quinta
Building and Safety, Department-
Nil
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: R
BUILDING ADDRESS: 80-279 RIVIERA
Use Classification: SFD Bldg. Permit No.: 9803-024
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND III Address: 55-920 PGA BLVD.
t t: City: LA QUINTA, CA 92253
By: STEVE TRAXEL
�l? Date: 11-2-98
Building Official
POST IN A CONSPICUOUS PLACE
i � `