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0107-072 (CRES)M LICENSED CONTRACTOR DECLARATION PERMIT# U) I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and fO$O 8�3`�? DAT . ,+ VALUATION •LOT TRACT ct Cl) Professionals Code, and my License is in full force and effect. O =) ch License # Lic. Class Exp. Date JOB SITE APN r` r- " �4 '.� [J . ItfO ADDRESS i=alt lin tl�9A fi�`L 6�kD Z r Dater• /��r �' Signature of Contractor N� / r y OWNER CONTRACTOR / DESIGNER / ENGINEER o0r`� .I, U �� _ �„_ . ...-------OWNER-BUILDER DECLARATION J T;,,R,C. DEVM,C5NAE:NT ,(3+MON Ka, DEVELOP7v1EW L"O RPORATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's„ 20 N 55-920 'GA t L6'k ~.IU) License Law for the followingreason: , « Z_ ( ) I, as owner of the Property, or my employees with wages as their sole Se(�ilt'0. ��`?2S�' C'.IS22'g3 � compensation, will do the work, and the structure is not intended or offered for l'fj�' lhfS CHUA 4676 sale'.(Sec. 7044, Business & Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed contactors to construct the project (Sec. 7044, Business & Professionals MO��p,,({R(;t;(1rf_, Code). LO () I am exempt under Section , B&P.C. for this reason fHME PARKt'@iO TP,=L!S :i3.3A:1;W, CO.YEPU,4 (t'7".>`17; 82Y36; N Date Signature of Owner m a Z WORKER'S COMPENSATION DECLARATION C:) < Cc I hereby affirm under penalty of perjury one of the following declarations: LO � O ( ) I have and will maintain a certificate of consent to self -insure for workers' PO17C`;PlbPATIO, 53 pp;SF X.LI.I L= compensation, as provided for by Section 3700 of the Labor Code, for the O � Q performance of the work for which this permit is issued. m Q () ,P-) I have and will maintain workers' compensation insurance, as required by OU.Q Section 3700 of the Labor Code, for the performance of the work for which this CL U0 permit is issued. My workers' compensation insurance carrier & policy no. are: Z Carrier Policy No. ob a °��YiT,8.WIIH,1W 4.O, '�Vt��a3d�Z4F►� EMr,94M COST Off' B"'�:A}�$�r'�'.£ UM— NO.f.�t 7Ma 748- Q (This section need not be completed if the permit valuation is for $100.00 or less). P� IR -M rim N,03A ' Ry J ( ) I certify that in the performance of the work for which this permit is issued, J°l,,M •0.19a,K FEE 101-000-439-1,18 u��•B� s' I shall not employ any person in any manner so as to become subject to the CX,3i9S`1'RVCT10N ia'09 101-000-4MIN)o $:5.22.50 ((f workers' compensation laws of California, and agree that if I should become rT C� ( �,�OT10 ?} +PA' gCa.ty �,�,,�t-000 &13,R!? f subject toRthe porkers' compensation provisions of Section 3700 of ,the Labor Code, I s all f6rthwith comply with those prov. ions. —..Date— `1��ApplLcar�t � .•-. r� f 1/� � �.- 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 hig° application. y 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 .9L: S-`i.`Iv+`fAt, "° STR'UM,1.014.AWD PLAX t;EEXX SM7.62 any permit issued as a result of this applicaton agrees to, & shall, indemnify ;FAN cq PRE._P.l TD IMIS $0.00 & hold harmless the City of La Quinta, its officers, agents and employees. D 0 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 '� PMMIT TEM DIDE NOW S87M permit, or cessation of work for 180 days will subject permit to cancellation. AUG 13 2002 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 CITY OF LA QUINTA construction, and hereby authorize representatives of this City to enter upon FINANCE DEPT. the above-mentioned property for Lnspe do : purposes. r ? .r' RECEIPT DATE ;BY DATE FINALED INSPECTOR Signature (Owner/Agent) • ��''"" � �`r � -� Datee4l • ... .....1n.0 --i w:: �..h._. �.�_.. . ^.'....'.�.:.�.... n. � •. � ..- ��'.,•�_Jt,._' .... ._... .._... .,- _..._ .. fA.._. . _ W ... .-_. �.- .�-.-..-�-A4-...-..{... .. - _.,d,.- �.- .�— - ..� xy ...�h.v.2 �....�..._.«..��.,�n.L.u...�-� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING- APPROVALS MECHANICAL APPROVALS Set Backs �-1-7-1pi Forms & Footings Q_c;4.p 1 Slab Grade --(` S7, Q i , Underground Ducts Ducts Return Air Steel Combustion Air Roof Deck 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 /A Final 2K 02-1 ,� Final POOLS -SPAS iii BLOCKWALL APPROVALS 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 Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: / R�M��jvh L1,5 1L, V 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) Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 8/31/01 No. 22434 Owner NameKSL Development Corp. No. 50-905 City La Quinta Tract # Street Avenida Bermudas Lot # APN # 773-022-032 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area Square Footage 17891 Type of Development Commercial No. of Units 1 Comments Office Building IL At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It `has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: .Commercial Building EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of .33 X 17,891 or $ 5,904.03 the property listed above and that building N• permits and/or Certificates of Occupancy for this square footage in this proposed project may now be,issued Fees Paid By CC / 1 st Bank - Mike Susick Telepaone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Signaturej! i Payment Received $5,904.03 Check No. 59203 IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -day approval period in which you may protest the fees or other payment identified bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to ollect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting O- nA m . 'D�?ve4 , C ity of La Quinta Developers Project Approval Form Prior to the issuance of Building Permits for the project listed below, the following Departmental clearances must be obtained. Please return this form to the Building and Safety Department only after approval. Contact applicant for resolution of conditions preventing or delaying approval. Project: Parking Lot Shade Cover- 3 structures 50-905 Ave. Bermudas Applicant Contact: Mike Cusick, KSL Development Corp. 564-3957 Application / Circulation Date: Community Development Department Christine111 Iorio, Planning Manager Public Works Department Steve Speer, Senior Engineer Building and Safety Department Greg Butler, Building & Safety Manager 7 3i O( 02 - Date dg///d/ at Date Date City, of La Quinta Developers Project Approval Form Prior to the issuance of Building Permits for the project listed below, the following Departmental clearances must be obtained. Please return this form to the Building and Safety Department only after approval. Contact applicant for resolution of conditions preventing or delaying approval. Project:. Parking Lot Shade Cover- 3 structures 50-905 Ave. Bermudas Applicant Contact: Mike Cusick, KSL Development Corp. 564-3957 r Application !Circulation Date:v�t 7.31 O% ate Community Development Department Christine di Iorio, Planning Manager Date Public Works Department � Yof eve Speer, Senior Engineer Date Building and Safety Department Greg Butler, Building & Safety Manager Date "'7* 1