9803-032 (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.
trLicense # Lic. Class -, Exp. Date
r5429 3 � '` , 3i31194
jDate'. r I j fi 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.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.
(++g�)• I have and will maintain workers' compensation insurance, as required by
Sec'tlon 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.
ZURICH 1NS. CU. WC' 6838955066
(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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code,, I 'shall forthwith comply with those provisions.
Date: ! I i f Applicant •4 x
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 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.
YSlgnature (Owner/Agent) Date
PERMIT#' CONTROL`F#
BUILDING PERMIT� .. :.
�5
DATE VALUATION S224,81&" LOT 27 TRACT
3/1 iAps
JOB SITE
ADDRESS +J sllVi�ilt
APNOJIr�%-1,3
OWNER
CONTRACTOR /DESIGNER / ENGINEER
KSL LAND III
KSL D lELOgviE CORP OR
35920 PGA BLVD
56-140 PGA BLVD
LA QUIN7'A CA 42.253
1,A QUINTA CA 532253
t7t�01.54-71t5r5 CBfA 4676
USE OF PERMIT
SFD
R
LOT 27,1OR11TACIE PLAN 1B. PFRIiiTT DOM NOT ]NCLUDE FLOCK
WN.LS OR POOL. PLAN (IWICK 1'��1�TION OF #� FS f 6UU(:Q) 7s�o FUR p�I
M1JT,Tff9_F U&SUANCF (:W SAVAF PIAN TYPE.
R j
t,44R
;t
CUST Nvi CONSI'RUCTION 2,65.5.00 SF n
FORC1111PATIO 3OZ00 3F CITU F LA aujNT6
s.iA LAOUC'Akik' W I 713.00 Sir
F fjlMA'110 (::aST OF CON:S'37RUC'TION 224,315,
44'
PERMIT FRE 8UMh1XRV
C ONSTRUC'f'ON FEM, 101-000-418-000 $1,077.00
PIAN (11POK.1T -Ft 101-(1Q0-439-119
NUX 11AN1CAL FEC 10 1 -000421-OW $79.00
LLECfRICAL Ffl�. 101-000-420-0017 $11V1.69
PLLJ&tBrN(1 FM, 101-000.41.9-000 5185.2.5
SI'►2ONQ440'!'iON1~' E-RESID )01 -MO -24140) $22.48
GRAD ILNG k'X 101-M-423-000 $20,00
INFRASTRUCT(312Is 1FEE 225-000-443-342 $4,961.98
ART iN D}1. BLIC; PLACES - RESW 701-(11)0-255-000 5312.t�t
St )13-'1 OTAL. C ONS'I9itYMON AND KAW CHECK $17,04776
LESS PRI: -PMD FEES $000
TOTAI, t'ar RA4✓ 1' F RON DUE NOW $7,047.76
f
4�.
RECEIPT
DATE
BY %
DATE FINALED
INSPECTOR
INSPECTION RECORD
1OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
- / _
F.A.U.
Framing
_
-
Compressor
Insulation
- Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
,
7/ eje-s-1
r` :z _
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg, Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
.,Waste Lines
- -
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-Z -
Encapsulation
Gas Piping
_
Gas Test
/0
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
-.2$
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
t
Final
Utility Notice (Perm-i-�-
_
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-orWse. For the following:
BUILDING ADDRESS: 80-320 RIVIERA
Use Classification: SFD Bldg. Permit No.: 9803-032
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
%f
Owner of Building: KSL LAND III
Building Official
Address: 55-920 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 10-28-98
POST IN A CONSPICUOUS PLACE