9801-054 (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
f 1 f - �31
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:
( ) 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 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
Sectien 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 Policy No.
Z11€LICH:1NIS, CO. WC 643896506 .
-(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 s
Date: h II fort with comply with those provisions:
pplicant
_g�-u
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 anis for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall; indemnify
& holdjharmless the City of La Quinta, its officers, agents and employees.
2. Anyspermit issued as a result of this application becomes null and void if
workJst 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 herebylauthorize representatives of this City to enter upon
the above-mentioned property for inspectionp pru oses.
Signature (Owner/Agent) . 11_1kate iOil
BUILDING PERMIT PERMIT# CONTROL'#
DATE VALUATION LOT 9801-1.54 TRACT . G572 4
5336,413.20 10 28 56
JOB SITE
APN
ADDRESS
37-849.INTE;RLACHEN
761-472-010
OWNER
CONTRACTOR/DESIGNER/ENGINEER
I;SI, LAN1D lI1
IC.SL :DEVELOPMENT CORP
5920 POA. BLVD
239'20 'PGA. 'BLVD
LA QUINTA CA. 9225:3
LA QUINTA. CA, 92253 ,
(7620)564-7166 CB1,4 467p ..
?
USE OF PERMIT
F
I LJ
OT 10, I f AGE PLAN 3 A:R-G3, .
JAN 0 8 1999
CITY OF
QUINTS ; :.�..
Cusa�r�iM CONS CRUC1IOv 4,047.00
.
PORMPATIO 51.9s
q
f.iARAGFJCARPORT 71.77 0 8F
CS i d;�gA2 FD COST OE CONSTRUC MON
3362,413.241
PERMIT F199 SUMMARY
CONSTR1JC71ONFEE 101-000-418-000 $1,469.00
PLAN CBE FEE .101-000.439-318 S1,^ 14,20
WX11:ANICAL F%FX 10)-000421.-000 $162.50
ELYC1 TICAL .FTE 161.4000-120-000 3? X2.69
PLUM1B(NO FIX 101-000-449-000 3260-30
8TRONGNOTION FEE -AM'11) 101-000•-241-000 $31,64
GRADING FEF 10 t -000-423-000 520.00
iNi~fLASTR0FCf`VRE FEE 225-00D- 3-3d2 561000.00
ART IN .PUBLIC PLACES - RES1'C 701-0410-255-000 $591.03
SUB -TOTAL CONSTRUCTION AND PLAN CHECK-
LESS 1'1"tE-P,A11DFEES
$0.00
TOTAL PERMIT FEES DUE NOW
59,983.62
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
1
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 ,3 -/8 —
Exhaust Fans
O.K to Wrap R — —
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 APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
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 Qd
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
Utility Notice (Perm)
COMMENTS:
("
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
Lf .;.,:.:.;�c ;;f issc:�:: �c, th,"s structure ivus in compliance with the. various ordinances
of the 'City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
57-849 INTERLACHEN
Bldg. Permit No.: 9801-054
Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND III -
Building Official
Address: 55-920 PGA BLVD.
City: LA QUINTA, CA 92253
By: - STEVE TRAXEL
Date: 8-5-98
POST IN A CONSPICUOUS PLACE