9809-081 (CONR)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
13 •: 3/31199
Date 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. p
(,) 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.
Lv'I1IC 'INS. C f.3. 'We 683396gGfi
(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 -1 should become
subject to the workers' compensation' prole/sins of Section 3700 of the Labor `s
Cdde, I shall forthwith comply with !those/provisions.
I,tSate: `�/ !� Applicant �Z✓~
� r
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's
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 pumu6nt'4o "
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..)°agree to comply with all City, and State laws relating to the building ;
C onstruction, and hereby authorize.rgpreseLtatipvos of this City to enter uponKthe�above mentioned p:e,,rty for inspectionses.
/,"Signature (Owner/AgeA� "' Date / 4 f,
BUILDINGPERMIT FERMIS" � - ---CONTROL'#��
f
1 / � ja qq� �q�qy�x/� �q/I
DATE 9' ' "' VALUATION j.0 LOT- '
R TRACT `8,11, V 1 .
410 �: VVV 111
y
• , __�.�
JOB SITE
ADDRESS idl :� B�r�F'��'[t\r
APN 760-490- 41`
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SL l..r'0.T"011j
KISL .DSIVE'10€aNIENTcot2p .
6-140 PGA -BLVD
.56-140 .E'GA R 1, N i)
4,E1 (J19rA CA 922x3
JA QUINTA Cil 92253
{760.564.7.iCG Cat3L, 467
,
USE OF PERMIT
324 ST. W&ftViiY1'4 AREA POICk WILDN Amc RESTROOM
TRACT CONSTRtXTZ®ti 8t,
w
MINIMg�gq �•v� �! I.1,g� w is �, 1p���•' �,i•+ �f.
...ti�'4d MIT •\J.k' '4.ONIST o'1a3�+6.N.5101N ,
�� �•.
17,59.1..2' 0
PLEA 4CIMCK Ft.�E 101-00-439-318 S1.2`L.SS
101-000--4:f 8-000
'HL `r G" RICAi ld�l.., ()ii-rt'a�,'Jt $39.98
P:LU11 t6114„ FES 10I-it(D0�119-CCH1 � 5.tzi;
STRO1dC; A40T1 N FEE - RESID - 1,01-000-2414)010 51.76
L4_FRA • rFWC 'g;KF FES ; 2.254)0-443-342 $395.+35
t
_ 5IJ13= '4T,11:• C:QiV tY(JL :CIS 11 1x�'.i}f. �)�T t.�;3 t1�(�3�r_
_ $824A4 . _.
I;L54 Flit; 1-��1.�J.i^. t 5
$0.00
Ph. .
F't♦,y t.i1 1. y q�
uv'TOTAL.PE1.tl:J,k'7.!!'�� .�!.��+MS' DGE NOW
PE
:^9i?ir' 4.44
SEP 17 1995
RECEIPT <o d,• �^� OATE4e;; Ste [�e 8' BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
71Return
Air
Steel
Combustion Air
Roof Deck-
/ 9 ,..
Exhaust Fans
O.K. to Wrap
`
F.A.U.
Framing
����
Compressor
Insulation
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,,,
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Footings �
_ Q� Z
�—� �
Steel
Electric Bond
Main Drain
Bond Beam
/��/ j�
�. p'r
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines—/��
_
,,�
Electric Final
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
Appliances�—
�61i//�/yyFinal
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
t
Final
Utittty Notice (Perm)
99
Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext. 235
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT: RCPT N:
CK. M CASH:
MUTA[S: DATE:
CERTIFICATE OF COMPLIANCE
(Government code 53080)
Project Name: Date:' September 17, 1998
Owner's Name: KSL LAND I I I Phone No.
Project Address: 80-393 Riviera, La Ou i nta . CA 92253
Project Description: Pool Building and Restroom
APN: 760 480 041 Tract #:
Type of Development: Residential
Commercial
Total Square Feet of Building Area:
.Ft.
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/she is authorized to ignno ehLof owner/developer.
C"/
Dated: Signature:
* * * * * Is * * Or * * * * * * Is Is * * * * * * *'* Is Is * * * Is Is Is Is * Is * * Or Is Or Is Is Is * Or Is Is * * * * * Is * * Is * * Or * Is * Is Is * Is * * Or Is
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCO TH ONE OF THE FOLLOWING: (CIRCLE ONE)
Gov. Code Aov. Code Project Agreement Existing
53080/65995 ' 65970 Approval Prior to 1/1/87
Note:
Num of Sq.Ft. 324
Dunt per Sq.Ft. $ :31
Amount Collected $ 100.44
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Admini
Not Subject to Fee
Requirement
suator to Charge
Certificate issued by: Marcela Valdez Signature: i
QXV1& d1WA
Facilities Clerk
NOTICE: Sad oo 66020 of th Govemmmt code enacted a Aumbly b 3081, tel nb u 549.S lis[Ites o the tate o Cab 1996 aarw Jm I, 1997, rtgoves 100
dtmsm Po a svnnm Douce m les •
time of Oaymm of school fees mitigation yaymmt or othc esactiam. Thio coda is m advise you thn my protest m regard m web smooma m the validity thiseaf 1 waonhoce wnb Seedou 66030 of the Gow®m Code ad other ap hp'caD4lav,
W__ with such payment or ofany other requir== as dmribcd m Sation 66030 ofthe vet®m Code Addidonafly, this oodee advises this the protm tbww most occur within 90 cAendar days dweaft.
NOTE: AB 2926 and SB 201 fees are capped at $1.93 per square foot for all residential construction, and at $0.31 per square foot
for commercial/industrial projects.
t
ARCHITECTS
August 27, 1998
J.R. Mauro
KSL Development
55-900 PGA Boulevard
La Quinta, CA 92253
Dear J.R.,
As discussed in our conversation on August 26, 1998, BBG Architects does not have
any objections to the reuse of the Ryder Pool Building on Pool Lot "B" in your project.
If you need further clarification of this issue please do not hesitate to call me.
cerely, 2'
Jim Deford
Project Manager
A BERKUS DESIGN STUDIO
26 CORPORATE PARK / IRVINE CALIFORNIA 92606 / 714/261-1795 / FAX 261-5515 / E-MAIL: BBGARCH@FLASH.NET
i