9608-044 (SFD)LICENSED CONTRACTOR DECLARATION.
I hereby affirm: under penalty of perjuFy`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 ,
Date Signature of Contractor
OWNER-BUILDER'DECLARATION s
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 propeity, am, exclusively contracting with licensed
contractors to construet%the*project (Sec_. 70444,,BUsiness & Professionals
Code).
O Lam 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 maintaiWl certificate of cohsent to self -insure for workers'
compensation, as provided forby Section 3700 sof 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;0.0-of0het I�� or Code, for the performance of the work for which this
P is Iss field" A) Workers' compensation insurance. carr a"r, j �po7 cyI'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 imany 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 those.provision_s.
Date: Applicant
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 comply with all City, and State laws relating to the building
construction, and hereby4uthorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. ;r f
Signature (Owner/Agent)Date
•
BUILDING PERMIT I■I
PERMIT# CONTROL#•
9608-444 3861
DATE V LUATION 5786.343.40. LOT.C1
1407.3-41,.1.
JOB SITADDRES. l�.f { {.�� t l �k.4
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
to.;�.fI.t;- fK.).�"-r�,i`'1�' RAM'i EV E,1..'�J.'.%46�
_
3* .140 1a'* ALV1 J.
1968 % f_,0UNi..r1k t' C1,U6 Dk #.itis
LA QUi:NVA C A .92253,
T31";.1LA! UDA DUNES4 CA 9210.1
11V 'o5f -I0IRR
(01911345-7755 C'RI::# 069
USE OF PERMIT
SiN it,I,:M,'J
R'I f., Y` .0W E-1 1,1N'.=
'
7y pp��
iYb� D 3;G4: R.B"F 6
�S'(900 fwl
4R�10I r-A►iB�'t�,1.t2: ' $533 tiQ. 5E
,c
AiNi•,'i.1QlATED \:. 151 1. F l.VNSTRVMOIN
'[,186,383.4 ►
��.1L•:��5�■I<!!, S'.1'�ify F74f t�"O.I����
C:4e'iN 'f.IONt.? 101,.{ oiR. -.000
$.1.,29,0*
mA13 L -'43v_ -K T Lic, 101-000-134a.�18
31A.50.51
r�llit:IlAfdi il: `IaTa IW_()0Gr2.1-000
$124.00
'EmcniTa11, ME E 101 d1(1C1-420.000
$189.60
PLUMMINGVEMP
$213.25
STO1NG A i TION I U, USi(3 . :..1dll�+ l� Ali=0l30
$28.54
GRAD= VM 101.400-423.000
ugFR1s"!''e2if("ruR:E n-% 225-000-4.43-342
K000,00 K000,00ART
IN f►{II�i,.:TC:PLA1tt",R8 - RE SIC 70i._M-2�J4)00
1SU8_1V) l' z3 RUM10N AND .PLAN CHECK
�j LL"8S i C'4Ft1flJ Fls:�:S
50.00
A� .IN1�1;LAMIT .�+' ;Ti i i�l1E NQiW
•• ' 0 3 1996.
SEP
59,;9 2 .
2<:
RECEIPT,
DATE
BY
DATE FINALED ,
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel fCombustion
Air
Roof Deck
Exhaust Fans
O.K to Wrap Q
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 APPROVAO
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI , Test
Final I
Gas Piping
PLUMBING Af PROVALS
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:
;
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)
Loll
cal
78-495 CALLE TAMPICO - LA .QUINTA, CALIFORNIA 92253 - (760) -777-7000
OF rN� fAX (760). 777-7101
TDD (760) 777-1227
November 18, 1998
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 as5'5'"47�3 Southern Hills, APN #769-820=016, Lot 6, Tract -28341
1, the construction of which building permit #9608-044 &'#9708-060 were.issued, will
now be addressed as 55;4.97 So.uth.ern Hills.
Please note this.change,and feel free -to contact me if:l may be of further assistance
Thank you.,
Sincerely,'
• i
Greg Butler J
Counter Technician
BUILDING & SAFETY DEPARTMENT
r
MAILING ADDRESS - P.O. BOX 1504 - LA'QUINTA, CALIFORNIA 92253 �\J
Ce. fica to of Occ'upa'
nc Y
O G .
M!
Cltj�.of La' Quanta_ s
Building and Safety Department-, OF-�
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 regu/ating.bui/ding construction or use. For the following:,
.,4 q7
BUILDING ADDRESS: 55-4-7-3-SOUTHERN'HILLS
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:- 9608-044
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: 8/-11 /97
Building Official
POST IN A CONSPICUOUS PLACE