9803-025 (SFD)(V lJJ
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LICENSED CONTRACTOR DECLARATION
I • I hareby 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
nd,-Professionals Code, and my License is in full force and effect. t,
License # Lic. Classes Exp. Date
Date I: _Jf Signature of Contractor-,
OWNER -BUILDER DECLARATION
I. hereby affirm under penalty of perjurythat 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). ,
() .l 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.
( 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.
ZLUUk 01,,11*4S. CO.
'INC., 6931ST 506
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 1 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' compensationprovision'sof Section 3700 of the Labor '
Geode, -shall forthith comply with'those p6vis onse/Z^- .•-"
✓Date "/ ` r _/A Applicant/ /I
Warning: Failure to secure Workers' Compe,? ation 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.
?..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-Cf0and State laws relating to the building
co struction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for insl5ectibn purposes.
✓Signature (Owner/Agent) Z t Date
..I.' 1, 17 ' �l`•
f PERMIT#
BUILDING PERMIT CONTROL.#
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_7 ADDRESS .: �itl�3'� . 6 l.�dl�s?i
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KSi;.DlsVELO.i'R ET41Ti;.U.RP .
�. 5510) i GA BLVD.' r:,
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USE OF PERMIT
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RECEIPT-
DATE' '
BY/
DATE FINALED.
INSPECTOR
INSPECTION RECORD
i
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
V_
Exhaust Fans
O.K to Wrap
%— 2
F.A.U.
Framing
_L
Compressor
Insulation
_
Vents
Fireplace P.L.
Equipment Enclosure
Grills
Fireplace T.O.
O.K. for Finish Plaster
Fans & Controls
Party Wall Insulation
Pool Cover
Condensate Lines
Party Wall Firewall
Gas Piping
Gas Test
�Y v
Exterior Lath
— t
Drywall - Int. Lath
.�
Final
1 / Z j rr 114 v
BLOCKWALL PP OVALS
Steel POOLS -SPAS
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
_L
Heater Final
'Water Piping
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
�Y v
Aooliances
I Final
COMMENTS:
ELECTRICAL` APPROVALS
Temp. Power Pole
Underground Conduit
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice
Certificate of'Occu'p'ancy
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
ollowing:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
Type of Construction:
Owner of Building: KSL LAND III
I W._A�
Building Official
80-329 RIVIERA
Bldg. Permit No.: 9803-025
VN Land Use Zone: RL
Address:
55-920 PGA BLVD.
City:
LA QUINTA, CA 92253
By:
STEVE TRAXEL
Date:
12-23-98
POST IN A CONSPICUOUS PLACE