9608-047 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under. provisions o
Chapter 9 (commencing with Section 7000) of Division 3 of the Business an(
Professionals Code, and my License is in full force and effect.". Exp.
License # Lic. Class Date
-wl- i a is 78106 .
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor':
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 fol
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with .licensec
contractors to construct the, project (Sec. 7044; Business & Professional:
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 of the following declarations:
( .) *1 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 3700 of the Labor Code, for the performance of the work for which this
,.. �l.,, t"i yes. c, ;i 1 '• 'I
permit is�Is�uednMy�ib�kers' compensation insurance ca'rner}& ��6�Cy 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, an&agree, that if I should become
subject to the workers' compensation provisions of Section, 3700,6f the Labor
Code, I shall forthwith comply with those provisions. rr
Date: Applicant—
Warning:
pplicant Warning: Failure to secure Workers' •Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the 'conditions and restrictions 'set forth on his
application.
1: Each person upon whose behalf this application is made &.each person at
whose request and for whose benefit work is performed under or pursuant to
any, permit issued as a result'of this applicaton agrees to, & shall, indemnity
& hold harmless. the City of La Quinta, its officers,' agents and employees:
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work -for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City,_ laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. >
�1
Signature (Owner/Agent) J S Date
�� BUILDING PERMIT � PERMIT# °°NTR°`"`�
AS
DATE „�.Y. iX�ALUATION 'U49 :839.20 LOT .9 TRACT. •1 3 8 �;
JOB SITE `�3-A ti "CSB t 6'l�.�c$+1 a1j��F APN�l.i��6-V Q�J
ADDRESS'
OWNER CONTRACTOR/DESIGNER/ENGINEER.
RANC110 CiVRIST`12'ANO DENT [fi!1-A11'tD-
it10.�'%ii\ E3.LV1►.. 79617 cmwrky CLUB Dit 9201
LA QUINTA CA 0215.3 RRMUDA DINES' CA 912,201
�U,19 Si+�3-lOfi£I {(�29j3�i 7755 CTM 1959
USE OF PERMIT
SiNGLE i~ANUL-V OW1,;1,iJiING
8110 21A LOT 9
WU-A 11 P Vznii /., I�•.VV Ni"
P-C-;1Z.0I/PA..1,10 36A,00 SF
C3 AAAlOWCARPORT 677,00 Sl:
LSTI:(tid4Xi,.•1ti.O COS! O.F 1.:ONST.RIX- 1ON'
a}'E,RMI1'
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Ct"9MSTR(, :Vf0N FI rM,
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I01-(WA39w3.1R
�tl e'iir\ivl�`rA3.. Fall
MI -000-42114M
WiCs'fR1:CAL iVix
101-WO.420-NO
P AISI O FM'
101-000-.491-000 !
$ t 7U 2S
; t�c�illYj 11.lMIO :FEF 4,133 [
i X14 Mflt3(3= 1 -AJC
2 3. ig
Ori:ANN
I1�1J2r�,S'1.Rt1!�Cltllii"s'FF .
'� >=i1W-443-342.
'%5,3Y446
AI,�T lid iatMfC P1;ACX S - R-8I•C 701.400-25-541100
5:354.611
SUB-IWAL
SEP 0 3 1996
I ,
i
RECEIPT DATE
NISMUCIllo iva) ADEN alrICK 58,225.73
LESS PRE-PfU.i:).KE's - $0400
ACJTERA'II'); VIRES DUE NOW
BY I DATE FINALED
INSPECTOR
W,225.73
INSPECTION RECORD
OPERATION
DATE
I , 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.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVAL.
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I -
Gas Piping
PLUMBING APPRO LS
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 llwla 17
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
&Notice (Perm)
COMMENTS:
6p " •JON .TANDY-
_4QQ"3`7630• Medjool Ave. t '
' APR
PIC
Qalm Desert, CA 92211 '
BU�i e�a, j Office (760) _772-7192
• • ® q��"���, Fax (760) - 772-7193+
P•ag.er. (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT, ,
V
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE 'INSPECTED TO THE BEST OF MY SIS NATURFF_OF' REGISTERED 1 ECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE ' 1 _
<� 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
TYPE OF ❑REINFORCED CONCRETE ❑ UCT. STEEL ASSEMBLY _ _ ❑
INSPECTION ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
PERFORMED • 5'15 ❑ REINFORCED MASONRY ❑ FIRE PROOFING •' �'
JOB LO + .— ^ REPORT SEQUENCE NO. „
-S�v�IRNoQ
L�'LS V��n1� A
TVP f RlJ[TURE O� - PERMIT NO. + ggJyl�`�� DA' OF WEEK
MATERIAL DJ�SVCR�IO�y ARCHITECT INdSPE TOR HRS,
CHARGED
J1•�' �l/O "i ENGINEER , ASSISTAAN`\T�SIi Lel HRS. CHARGED
u.
GENERAL
-DATE
INSPECTION CONTRACTOR �,..] CONTRACTOR
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COPY SENT TO CUEN _ CONTINUED ON NEXT. PAGE ❑ PAGE ' OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE 'INSPECTED TO THE BEST OF MY SIS NATURFF_OF' REGISTERED 1 ECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE ' 1 _
<� 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
TYPE OF ❑REINFORCED CONCRETE ❑ UCT. STEEL ASSEMBLY _ _ ❑
INSPECTION ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
PERFORMED • 5'15 ❑ REINFORCED MASONRY ❑ FIRE PROOFING •' �'
JOB LO + .— ^ REPORT SEQUENCE NO. „
-S�v�IRNoQ
L�'LS V��n1� A
TVP f RlJ[TURE O� - PERMIT NO. + ggJyl�`�� DA' OF WEEK
MATERIAL DJ�SVCR�IO�y ARCHITECT INdSPE TOR HRS,
CHARGED
J1•�' �l/O "i ENGINEER , ASSISTAAN`\T�SIi Lel HRS. CHARGED
u.
GENERAL
-DATE
INSPECTION CONTRACTOR �,..] CONTRACTOR
lie Ps �� U -M, - 1 .14sC la s E (/,�3 � p '
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COPY SENT TO CUEN _ CONTINUED ON NEXT. PAGE ❑ PAGE ' OF
'd Certificate on ff Occupancy
City of La Quinta
Building, and Safety Department
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: 55-515 SOUTHERN HILLS
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:
9608-047.
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. CR,AWFORD JR:
Date: 5/13/97
Building. Official
POST IN A CONSPICUOUS PLACE