9605-137 (SFD)I i
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
M797j 13 1/3� tft
Date --1/), ,`? Signature of Contractor
r
OWNER -BUILDER DECUARATION
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 property, am exclusively- contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). I • -
() 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:
( ) 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 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier :3,i''f1.ft: PtJND Policy No.-v6lkuj 74
(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, -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 provisions. ..
Date: ''� A��� f Applicant ^''`
Warning: Failure to secure Worker`s"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 i
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,focinspection purposes.
Si nature (Owner/Anent)
BUILDING PERMIT
G
-PERMIT# CONTROL#
3 518
DATE VALUATION (.y1 * LOT
9".4L137
TRACT
29450 PH f
JOB SITEIltr
141-OW41' -04(1
APN
ADDRESS SMI6115I4�T��,[1,LACI[EN
T'i.ri,�i G 1S:�1; k Eye
761470-024
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1 .41. i,r1NiJ lI
fiANO10 C1�i�D4'1.'f1AN(i.f�T:N'�i.Ot'itiii:�
M-140 KjA f3I.Vc7:
700-87 COt MMY CLUB DR 0241
L.A QUIN`: -A C.A 02253
HV IIN4f 1Dt1 011N ES CA 91201
{c+l t� 1 •4-10�tR
�f i ) 315=7 75 CB1.4 1969
'1a1�-+ \
USE OF PERMIT
• ftif-lif#>3-a19-(_�
T+�I iY.1An,y,
tS
SjsJO,L']P FAMII.4` DW1-I,LING
26 c:OtPORiVfF PARK
141-i}W2,1a•ra
(KVTNK CA "H
TIM I1FR1TAoF Cc:rl.(.T:C,"]'3ON AT POA. WT'gr
PLAN i-fiR
1(11 Ct4ki- "1000
Ct),:'IX)M C<?N S'f"ftt7t," 10N 7,65.5.00 SP
Pt.' RC71 WATIO %02.00 `.SF
0AR.AG ,/C'Att 0kT 713 Off Sfr
JUL 2'
:1996
AND PLAN CHECK
LPSS PRl?-PA1f,) P113S
BY - I DATE FINALED I INSPECTOR
$7,705.;;[
SO.Ot)
$7.705.73
1r ERNIrr FEE S[11%1MARV
r;t71' S.1i1Rf:}t,;r10NTTE
141-OW41' -04(1
T'i.ri,�i G 1S:�1; k Eye
101-0M439,318
$877.29
Nl i.11N1t�AT, fists
10114"4121-000
V79.00
W.Et;"!RICAf, !`T is .. -
1{1(-(1114-X24-4C9i)
elf .t,!�
�'i.tlt�h�r�r��i�rr - �
• ftif-lif#>3-a19-(_�
Stz?�.i� -
SlInNI G A110TIOh FUM - ](Gist)
141-i}W2,1a•ra
ORAi)lNGF-At
1(11 Ct4ki- "1000
s2t).ut►
i'NVIO" S7`RIRMIURH FEE
225-M-443-342
1, G7:iEf
A1.fL11' FN f"139f,Tt� to}.nt;i:`l dtlsStl; 7f)i•r,{)ij-S fSIN3
';f«�#�
JUL 2'
:1996
AND PLAN CHECK
LPSS PRl?-PA1f,) P113S
BY - I DATE FINALED I INSPECTOR
$7,705.;;[
SO.Ot)
$7.705.73
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.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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 Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS'
Gas Test
Electric Final
Waste Lines
Water Piping
Heater Final
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)
i-'
Certificate of Occupancy oto �L,
City of La Quinta
�
Building and Safety Department OF,.,E°`'
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: 57-615 INTERLACHEN
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9605-137
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: R-3
Owner of Building: KSL LAND II
Building Official
Address: 56-140 PGA BLVD
City: LA QUINTA, CA., 92253
.By: DANIEL P. CRAWFORD JR
Date: 4/11/97
POST IN A CONSPICUOUS PLACE