9608-045 (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.
La'ense #r Lic. Class Exp. Date
59/975 -- "� /i311�Ni
Date Signature of Contractor" + ,
OWNER-BUILDER�DECCARATION f
I hereby affirm under penalty of 'p'erjury 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 theproject.(Sec. 7044, Business & Professionals
Code).
O 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, o& 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
Section 37,00 of the Labor Code, for the performance of the work for which this
permit is Iss a My Workers' compensation insurance ca'rfier a 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 Calif orrpia,-and,`agree that if I should become
subject to the workers' compensation provislons.of Section 3700 of.the Labor
Code, I shall forthwith comply w,ith'those provisions. '
Date: Applicant a" ?
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, indemnity
& 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, repr` Es natives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) spate
BUILDING�q .
PERMIT# CONTROLM
8 G
3PERMIT
DATE -W @.i.2-3
VALUATION .A,7,`6*70 • LOT
-7 TRACT�t41 A w `
_'ZI
JOB SITE 1 y ' SOIL jjHE N MILM
APN 769-820-016
ADDRESS j
OWNER
CONTRACTOR/DESIGNER/ENGINEER
i�� I.,����1?'II
!�-,�3C'9�t� C�i,!'(S'�`�:�`�J �•E�;?i..t�!'11��i+
;iii 146 PGA BLVD.
79687 COM MY CLUB ISR. 6201
LA t;;iilfivTA - CA 92253
BERMUDA DUND', . CA 92201
({►.K 64-1099 F
(629)345-7755 - C��e 1`.�fg
USE OF PERMIT
SM0 E1 .V , MILY UWI=I..LING
P0fWH/PA'130 302.00 SF
0ARA.1Q1:�X.ARPO:it'.r 661,00 SF
ESTIRIt1 V-4) WST OF CONS CRIJM;ION
223;796.70
OO.NSTRIX-1710NFIT-- '101-000-4194!!IO
}L:�:sc: Fr•,1 IQI �€�a��a-�
$374.53
i�!IIStIiArJ1CAL F'E'h" iQl-Qf)ii-1'x.1-�itid
'�".�.i't0
1st..EC" LkICA.,` EE 101-000.420.000
.11.63.45
1'7 t1M i]NC11 13 101=QfK1.4 9-Q0t1
B.lRS. S
S7'CING MOTION V, . -1ZES10 101.060 -241 -WO
$244.38
WtsA1.r-� 1,01-00042�00
$20.00
1AA["RAS'1RW4' fRF.,. raV, 223 -W -M13-342
,aktS.t?a
NRT 1•Af t>w,IC'jn.4<,xs kt ; :rr 701: 000-2.x,5,000
`;in!3.49
SUR-Ir:'i'i'AJ, CC2Rtm[,)C't'ION "D PLAN CHECK
$7,672.85
LESS PR;r-PA D FEES
XW
PVIRAI*IT FE Cis ow
VIVEN
t 6Ep n 3 1996
RECEIPTDATE'
.
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
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L. f I
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVA S
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APR VALS
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 MaZ
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures'
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
• �pleb�'r'I'�2 chi ' : '
76-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 - . (760) 777.-7000
OF ��o . FAX (760) '777-7101
TDD .(760)'777-1227
November 18, 1-998
r
RIVERSIDE COUNTY ASSESSOR'S OFFICE
3255 East Tahquitz Canyon Way, 'Suite 114.
Palm Springs, CA 92262-6962
To Whom It May Concern:
Please,be advised of an address change for the following structure. The structure
formerly addressed as [55T489ISouthern Hills? APN #769-820-016, Lot 7, Tract 28341-
1, the construction of which building permit #9608-045 & #9612-110 were issued, will F
now be addressed as 55i4-99TSouthern HiII-S
Please note this change and feel free to contact me if I may be of further assistance.
Thank you.
Sincerely.,
Greg Butler
Counter Technician
BUILDING & SAFETY DEPARTMENT
MAILING' ADDRESS - P.O. BOX 1504 — LA OUINTA, CALIFORNIA 92253
r
Cet.ifcato ofOccu panc,�,
T
Cit of Lauint
Q a
Building -and safetyDepa-ttment O
F
This Certificate issued -pursuant to the requirements of Section 109 of the Uniform Building Code, •
certifying that, at tho,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:55 -484 SOUTHERN HILLS
M
Use Classification: SINGLE FAMILY DWELLING Bldg: Kermit No.: 9608-045 t
Occupancy Group: R-3- - Type of Construction: VN Land Use Zone: R-3_
Owner of.Building: KSL LAND II, Address:. 56-140 PGA BLVD �•
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD.JR.
*Date:.. MARCH 17, 1997
Building Official
POST IN A CONSPICUOUS PLACE
�srvOFL 0101NTA JON .TANDY.
• 37630 Medjool Ave.
APR ® 1 RECD Palm Desert, CA 9221.1
Office- (760) 772-7192
LNU SAFEMix (760) - 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT,
TYPE OF
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY, , ❑
INSPECTION
❑ POST TENSIONED CONCRETE i ❑ ASPHALT i ❑ OTHER
PERFORMED 41
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCA 'S U_(14 �„
• /� ^�/�
REPORT SiOUENCE N0. .
TYPE U URE * �� ,
PERMIT NO.
M
DAV OF WEEK
MATERI
DE IP ION '!
Z)
ARCHITECT - - - -
INSP§FTOR - -
HRS. CHARGED
-71T-I
ENGINEERASSISTANTS
U
HRS. CHARGED
I
INSPECTION GENERAL + , SUB (/'� w
DATE CONTRACTOR Q kis _60 • _- CONTRACTOR Y . �Z✓J I �?
N ecTi Z- oA-7E "� ' � ' 7•S - (a-1Clc
1 �
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y
" COPY SENT. TO CLIENT
CO INUED ON NEXT PAGE 0
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY SIGNAT RE OF REGISTERE SPECT
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE G
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED (� �
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS -OF THE..
GOVERNING BUILDING LAWS.' DATE OF REPORT REGISTER NUMBER