9803-031 (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.
License #I Lic. Class _, / Exp. Date
{',
4
yDate �! ' 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 ) 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
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. i
(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
sect to/he workers' kers' compensation proJv�isrons, of Section 3700 of the Labor
Code, I sh, all forthrwithlcomply with those'proulsfons'."
✓Date: ` ( t /Applicant
�� 1
,•F� r t •. r J • `-
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 .1 i`oUurposes.
VSignature (Owner/A entjDate'
BUILDINGPERMIT PERMIT# _ CONTROL#
DATE VALUATION , LOT TRACT
J
Jots 511 E
ADDRESS-»)G��'����AZe�
APN 701-080.i173
OWNER
CONTRACTOR / DESIGNER / ENGINEER
j. 1,a_^� �f i1 17�
.f Y,l1 ..i INN d •..1
,114 M . !. 1.i n,.f f. 111 1. 4,. . 4
S, IY 11"11 l'e /:tfif9'ENT." P��jR
55910 �� ;� ti
,- 40 PG. Ee SIND •
LAQUfNTA !x (,;,/., 9��53
f.rlt�1-1fN A �;1� ����53 '.
(760)564w-7166 C mg,-# 4176
USE OF PERMIT
��L�
Vis;;' •.r.
�
f�TflUT 1Ji,iOi'NK,
WA11,`:101K POOL. �'[.Mi CHECK 3s F +;�tc'I'3CS,Si t,i ! f: iZt�.f?f i Ft.C) 740, Cgft
3147tS.'k'if�l .i;, ;[S i ft\NCR OV SSA.t'vti PLAN ':AINTE.
"I
i'�7ttr"1flFAdfU � ys
®F LA QUiN
GARA_0VCARP0RX 6" 17.00
W.
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P, 101
GFl�rf., If?.l-000-4+9-3i.R�Ci,2:
tAWHANICAI, i:T,; ', lfl1aC3t�d3I: OClfl a�.:.5t;
t.-,HC"'.rRfCf,:M14 I01_000-420-0 �i7f.5 i
PLUMBING FFh AOI -000-419-000
f s�i �, stn? 1 0FEE -:!7> ; 10J reett►�z:�z-t� 0 S21A�
0-RADING 14'I.:iS 101-1709423-0040. af,fit?
�N.ii2.A.� 72f=4r�r�tr;t:��ia • ' ��5-�iit�f'l-E�f3=3�2 ��.�z'�.�8t
A!Z'1' IN PUBLIC PLACES-'RESIC 701-000-215.000 ` $34q-a.CiE�
0-S-tiV?AL t:"ONS-!'RUICRO.NAND 'PLAN CRE Ck'$7,!34A7
LESS PRE -PAID r IE S
$0.00
v,�ci i�s vvicTkiow
$7,$3447.
RECEIPT*
DATE' •
BYS
DATE FINALED
INSPECTOR
.10
INSPECTION RECORD
OPERATION
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
Z
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
BLOCKWALL A PROVALS
POOLS - SPAS
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
Heater Final
Water Piping
Plumbing Final
;Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection —Q
Pool Cover
Encapsulation
Gas Piping
Gas Test
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
Final
Utility Notice (Perm).
Certificate of Occup'a`ncy-
City.
of L.a 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
M.,
80-336 RIVIERA
Bldg. Permit No.: 9803-031
Type of Construction: VN Land Use Zone: RL
Building Official
Address: 55-920 PGA BLVD.
City: LA QUINTA, . CA 92253
By: STEVE TRAXEL
Date: 12-3-98
POST IN A CONSPICUOUS PLACE