9803-028 (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 ,# Lic. Class Exp. Date
r/34283 T -A 313 1 N9
V Date) ` 1 r Ggnature of Contractor
� f r
t OWNER-BUILDE 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.
(X) 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.
ZUh C11 INS. CO. WC 633896506
(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, kshall forthwith comply}u6th those proofs o' n
bate: � % ZAppliclant !
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. /
, Signature (Owner/Age nt)f Date
BUILDING PERMIT PERM'T�, S CONTROL
DATE VALUATION $2 LOT -23 TRACT -69
ADDRESSJOB SITE
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KSL LAND ifl
ISI, DEWL1' OPIbilsN70DR-P
5_ 2.8 PGA BLVD
56-140 l'G_A BLVD
L.A t uwrA Cts 92253
ISA QUINTA CA 92253
{7t5U�S �j.71ei® rBLO 46761
USE OF PERMIT
SI~D
Laf23, .r! i'E RITAGE PLAN f A. P IZMIT DOES NOT INC LLQ BLOCK
WALLS OR POOL.
�� I
AR
i U 1998
CUSTOM t, ONSTRUC TIONT 2655,00 3F
c3 t rrnAxlr *2-00'CITY ®F
QUINTA
UARAGE/C:iVUh'*T 7I3.00 :st
a
9'r.'rIMATED COST OF CUNISTRUC"O'N
224.31&90'
PERMIT YLEE SUMMARY
t'0N3'gWC"r1oN Fff. 101 -MI -418-000 S 1,077.(N)
I-IT.A.N C'fIl;CK !()! fi(1() 4 t . s SR71-19
; ','UTANICAL FE2 101-000-421 AW STS 00
130X"IVIC:AL f•E6 St64.64
PLU NOMNO Plai. $183.25
STRONOMM'TON - Wrlgln ?.Q1-fK3(? 24i-(1ti(T $2148
CRADING IAF - 141-000-423-000 11.!8.00
JNFRA31RUC1 TUkt, FU x.25-t?(iC1 443-342
ART IN PUBIAC PLACES - RUSIf, 701-M-255-000 isi2 ik
,91TB-Tgr!AI, C: EJ:I'3SI IK'nI ON AND PLAW CHECK
$7, ?-A
;;s5 PRE -PAID IFE.ES
$000
TOTAL PERMIT WES DUK NOW
$7,705.73
L
RECEIPT
DATE _7y_/
DATE FINALED
INSPECTOR
f' -
k.
INSPECTION RECORD
,OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsI_q_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
— Q
F.A.U.
Framing
7 —
Compressor
Insulation
Fireplace P.L.
_
Vents
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath—�—Q�
Final
Final
BLOCKWALL AP ROVALS
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
4—
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
17
Gas Test
Appliances
•
Final
Final
Utility Notice (Gas)
ELECTRICAL 4PP1ROVALS
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
R
r
Final
utility Notice (Perm)
COMMENTS:
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 tune 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
WIL
Type of Construction
Building Official
80-384 RIVIERA
Bldg. Permit No.: 9803-028
VN Land Use Zone: RL
Address: 55-920 PGA BLVD..
City: LA QUINTA, CA 92253
By-, STEVE TRAXEL
Date: 12-21-98
POST.IN A CONSPICUOUS PLACE