9705-014 (SFD)i
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
73428:11 :3r3I/91
�
�D tee�� � ?7' f Signature of Contractor � t I
_ T
OWNER -BUILDER DECLARATION a
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.
I have and will maintain workers' compensation insurance, as required by
S'ecfion 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.
7AIRIC111 CX). *A: W)MM-505
(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 tprovisions. t �,
Date:-'. Zj`-JApplicant''"/�. �% l ,� 1 V tf�
r�
Warning: Failure to secure Workers' Compensation coverage is unlawul 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/Agent) +�+ `Date
BUILDING PERMITPERMIT#
C°NTRDL#
doll 2A
5.18
2:
DATE S�� tq% VALUATION$241,03910 LOT TRACT It
JOB SITE
ADDRESS v� l✓%�1�`I
APN
Jbi-St�Ii-{ii2
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KS1, LAND It CORP
KSi, Dl:V[?l..011K£I: ITCi,RP
56140 Ih YA BLVD
56140 I'Crti 131, VU
LA QUINTA CA 92253
IA Qj alrJ7A
('A �►2253
(70)771.3*42
C11110 076
USE OF PERMIT
SF'I:t -14 14t'I'AMPLAN 28
(,;U SMOXI WNS1RUC t i0N 2,872.00 5F
('UftCtltijA.Tlu :3G4.U0 air
UAR AGUIC;ARi'QRT 677.(0).3F
NST111"XfE D CWT OF CONSTRUC, fION
24113"120
Pt` R.A ff VeX SUMMARY
CC) N,'STRit(,Tlf:►N FIR1 l 1.01-000.418- U
rkN�ft���geII?/IC;l'4PP��F?t���
tI/t�{�!-OrM�(�?-�(3o��3g1K
i.rR-MIF�l' ICAL. FHL . 101-000.421-000
i» RC'f.[ ICAL kk's#. 101-000-42(OW $19D. �b
6•�
Pl.ttm}11NCJ 01 101 -OW -419.000 3179.1.5
STR0140?41 TIONF01H.R:t tti) 1()I=(ill(?-14)-(M 3^-1 18
�
`r
OROI i/IX 101-tiW423-000 3r�J.€ttl
_.-7. '—
E
iNFttA31".1tUC;TUk1i #Milk 2jSi70f} X1$3-3162 35,332 .4,10
ART M l'(.113f.1(. KACHS - RES10 7014tM." S11AX?
a.:
S1J VII(.YrAL CONS"'1`12.f.tCTION AND PLAN (3 C#K —
45 S. 73
LESS PR, CA1D Fr-,I,1,St.
- 1110)
TOTAL PERMIT IT Fla~M 011b; NOW
SR.225.73
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
7
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing L d
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
G
Dryygll - Int. Lath
Final
Final —it, r
BLOCKWALL APPROVALS
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
4wd L17Neater
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
Final
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)
COMMENTS:
.JON TANDY
®�NQ�14,1V 3580 Condalia Ave.
Yucca Valley, CA 92284
SPEC IALI NSPECTION SERVICE _'�P�` (619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF ❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY ❑
INSPECTION ❑ POST TENSIONED CONCRETE ❑ ASPHALT OTHER CJ "
PERFORMED ❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB C N REPORT SEQUENCE NO.
JoK
T' Ooo 4I,I[TURE �Q If 0 / PERMIT N0. , 2,-c(7 DAY OF WEEK
MATERIAL DE RIP ION /`L.^! ARCHITECT I SPECTOR / HRS. CHARGED
15;
_I IA f4c
ENGINEER ASSISTANTS HRS. CHARGED
INSPECTION GENERALK'J SUB'/J�•' 1
DATE CONTRACTOR l ` .S. I - CONTRACTOR WLI h1 lj-
G 04' &ASC-- o "c c& i b P.
__S _ x D X_ S% C®L
4
COPY SENT TO CLIENT '
a
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
rItN ON NEXT PAGE ,❑� AA I
SIGNATURE OF REGIS�TEERRECC
9---.EDATE� F�REP_-.RTiiaii....i��Pef
PAGE OF
CTO
-T
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 or use. For the following:
BUILDING ADDRESS: 57-427 RIVIERA
Use Classification: SFD Bldg. Permit No.: 9705-014
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner.of Building: KSL LAND II
- Building Offici
Address: 56-140 PGA..BLVD
City: LA QUINTA, CA 92253
By:. STEVE TRAXEL
Date:. 2-10-98.
POST IN A CONSPICUOUS PLACE
d
P.O Box 1504
78-495 CALLE TAMPICO
1.A `QUINTA, CALIFORNIA 92253
July 13, 2001
v
(760).777-7000
.FAX (760) 777-7101
Mr. Bruce Lindell
57-395 Riviera
La Quinta, CA 92253
Dear Mr. Lindell:
Please be advised of address changes for the following structures. The structures
formerly "addressed as: �a7=395-Riviera, 'Lot 18-APN#761-560-010
57-411 Riviera, Lot 17-APN#761-560-01.1
57-427 Riviera, Lot 16-APN#761-560-012
57-443 Riviera, Lot 15-APN#761-560-013
67-459 Riviera, Lot 14-APN#761-560-014, the construction for..
which building permits 9705-016, 9710-168, 9705-015, 9804-098, 9803-010, 9809-258,
9902-101, 9705-014,:9712-068,.9811-134, 9705-013, 9711-075, 9712-025,'9708-072
and 9712-017 were .issued, will now, be addressed as follows;
(80=425 -Riviera, Lot 18 - Lindell
.80-455 Riviera, Lot 17 - Soderling
80-475 Riviera, Lot 16 - Gould.
80-485 Riviera, Lot 15 - Westergaard
80-505 Riviera, Lot 14 - Schweizer
Please note this change and contact me directly at (760) 777-7019 if I.may be of further
assistance.
Thank you.
Sincerely;
Diane Aaker ,
Senior Secretary
Building & Safety -Department
J