9708-072 (SFD)r
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
. 't � `' , ?s i:�!+icDatew342
r 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.
`T) 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.
(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
§(ubject to the workers' compensatidh-provisions of -Section 3700 of the Labor
Code, 6 all o �%wi h comply with those' rovsigns. t
YYY Date: JJI .// Applicant i•y
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 complywith.all City, and State laws relating to the building
construction, and hereby authorize representative of this City to enter upon
fie above-mentioned property for in purposes.
y�
(Signature (Owner/Agent) r�'`�:� ate `
PERMIT # CONTROL #"'
-` BUILDING PERMIT
DATE Q� 5 VALUATION S2$9,20 LOT 14 TRACT
JOB ADDRESS s .M:1Si _1VIE
ADDR
APN
OWNpER
CONTRACTOR /DESIGNER /ENGINEER
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14�.,SL T,ANT) 91.
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L Qt CA 922.3.4
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(760)771-W2 ('.81.0 4676
USE OF PERMIT
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AUG 15 1997 •Iw•(Y-11'.A-, PERMIT FERE MTR INCAV .
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OF LN TA
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs '1
Underground Ducts
Forms & Footings
Ducts
Slab Grade 0
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap ,
F.A.U.
Framing 7
Compressor
Insulation IW& V7
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 y
BLOCKWALL AP ROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 7
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 7
Encapsulation
Gas Piping
Gas Test
Appliances
Final
t
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fi dures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
4
rte•.
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045
TYPE OF
INSPECTION
❑ REINFORCED CONCRETE XSTRUCT. STEEL ASSEMBLY
0 PST TENSIONED CONCPERFORMED ❑ ROE NFORCED M SONRYRETE C-) FIREH ROOFING •
❑
OTHER t _)Q`\ L
JOB L TION
�
REPORT SEOUENCE NO.
T 0 TR TURE
•RIAL
-
PERMIT NO.
D lE _�
DAY OF WEEK
MA DESCRIPTION
ARCHITECTTOR
-
HRS. CHARGED
^ `
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
SUB
CONTRACTOR
•
i
Q\nws
(t
1
oy Oq CO. 's
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE ❑
PAGE
OF
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.
W�
IGIRE OF REGISTERED IP4PECTOR �.
DATE OF REPORT REGISTER NUMBER
tP
.
e
rtificate of Occupancy',
City.of La'Qutn'ta',
a
Buildinga.nd SafetyDe artment ��Mo1
_p
T .
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:
BOILDING ADDRESS: 57-459.RIVIERA
Use Classification: SFD Bldg. Permit No.: . 9708-072
Occupancy Group: R 1 'Type of Construction: � VN Land Use Zone: RL
Owner of Building: KSL LAND II Address:. 56-140 PGA BLVD.
City:. LA QUINTA, CA 92253
By: 5I EVE TRAXEL '
Date: 4-22-98
Building Official
c r
®1■
POST IN A CONSPICUOUS PLACE (7)
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