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9608-046 (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. License # Lic. Class Exp. Date .i'.J70i E 1i 11i51ti Date 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: t ( ) 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). as own er'of the property; am exclusively contracting, with licensed contractors to.construct thefproject (Sec. 7044, Business & Professional's Code). O I am exempt under Section - B&P.C!for this reason Date r'. Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirrri 'unier penalty of perjury one" of the following 'declarations: () I have ano 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 3700 of�`tlge .Labor Code, for the performance of the work for wpich this permit is Issuer Mytworkers' compensation insurance cdrner �`�'by d' & pohc 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 im *I: er* as to become subject to'the workers' compensation laws of'California, and agree that if I should become subject to the workers' compensation provisiops of Section 3700 of the Labor Code, I shall forthwith comply with those;proyls'lons:' , 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. 3.706 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 inspecfi'onipurrpoossees.% Signature (Owner/Agent) BUILDING PERMIT - FERNY" °°NTR°`" DATE � VALUATION ir@736.. -13.40) LOT cel TRA 341- �. JOB SITE w��' )..l A�j H,lnj APN 76 '3ljj�.JJA ADDRESS OWNER CONTRACTOR/ DESIGNER/ ENGINEER .31. /AND tf RANCH -0 i1kyfS1�N0� „YElJVEy >ti- I11(i i'C3tS .1i., t>. - 79687 COUNTRY CULIE11 it fJii.l LA QUNT'A, . CA 92x83 BERMUDA DUNES- CA 9701. tGly')5v •10R (6101 454755 C13'f.,i1 ' 1969 USE OF PERMIT �3i.fv+41.�:; NlA1Vi3.i:.1f7.f3C�1�l.it:,1TVCi . WD1AR►0T8 ;.. 0ER.nGWARPOR s S MIMAI'l?.0 WXOle CONST iTLICf'[ON 18649140 VERf19IT E.#+.K NUMMARY C'O:KSTRUCTlCM2F FII 101000,418.00 ? $ t,d rT4.Qt1 PLA11 tFMCK 11-9E. 11rrLiCi AMCAtL.RR 10E -M -421-M StFr1.{)f? aFG1:12TCaiI.111� 101.-UU()ba2 (1i) S189.60 &'[ i1f1CR1t y F' t U 1-{)4p# 1 �►h(1UU S211-25 STON10 ibIC71'V ' O kWlb ` .101-000.241-000 $23.64 t RriOitvf.l?# 101-000-423.000 INFRMI.VI CTURE RE 125-M-443-342, .Ut►A.GU ATt'o` i1+{ )'1JP)1.lt" 1iaAC`ES .. f2ES11� `701 QUO.25a-{HNJ 3465.968 's"'* 1JOUCI '10N. I�dIi'1..A C'I1.CGI� 'S9,3y .37 LESS ,P'Rh-I AIT) C1"'1 S AD $0,00 ��Eti�011fT "�'EWS MAUI+,:t�tClW, $9,392.37SEP. 0.3 By RECEIPT DATE 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 X,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 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 APPRO ALS Gas Test Electric Final Waste Linesa 44,a 19 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral 7 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) Certificate of OccPuancy �� City of. La Quinta X73 Building and Safety Department OF,.° lam y 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: '55-501 SOUTHERN. HILLS Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9608-046 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: R-3 Owner of Building: KSL LAND -11 - - Address: 56-140 PGA BLVD City: LA QUINTA, CA., 92253 By: DANIEL P. CRAWFORD JR. Date: 7/30/97 Building Official POST IN A CONSPICUOUS PLACE