9605-138 (SFD)LICENSED CONTRACTOR DECLARATION
CO I hereby affirm under penalty of perjury that I am licensed under provisions of
F_ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CV UJ Professionals Code, and my License is in full force and effect.
:D M License # Lic. Class Exp. Date
C) LO
Lu r- B
Z Date 1 �'Signature of Contractor
U °� -OWNER-BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a-
Cn License Law for the following reason:
Z_ ( ) 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).
cY) () I am exempt under Section B&P.C. for this reason
L
O N Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
CL
p 2 Z • I hereby affirm under penalty of perjury one of the following declarations:
p () 1 have and will maintain a certificate of consent to self insure for workers'
X W L= compensation, as provided for by Section 3700 'of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q 0 ( ) 1 have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
d rn F<:
permit is issued. My workers' compensation insurance carrier & policy no. are:
�r z CarrierPolicy. No. r
ob'Tt! T1� FUND 2'19 94s(it)t)m; �i
C)
J(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,mIshall) forthwith comply with those provisions. f '
Date:�ir�:, 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
�rVlp & 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 issuanceof 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 inspection purposes.
Signature (Owner/Agent)
BUILDING PERMIT PERMIT# CONTROL#
G 1Ll[
3 519
DATE VALUATION LOT TRACT
. '�.�, _�� � .�.�2fi6,�?3.�.�tSi d • �hI � 1'11 1
JOB SITE
APN
ADDRESS �7-64l.Tt�' bitLA�:IENN
761-470.024
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.X
maDEV[ :?'i 1
P�AlCI /GI LiTIS
PGA�� ND.
DR #F1011
ss">1hA"r E:tti�+,
A
LA
LA 01JI_iV I.A. CA 9' 2.53
ATNi°PE�:T,i�'y�Ci.Uf�
BERMUDA A D1„Ii�FS- CA 92201:
yi19)16,I.itmR
rt.I9)345.7.155 C,13idt 1969 -
13 X ARCIfC'lIii," rS
USE OF PERMIT
ti3WILE' VAA11L5' f WlhJJANG
26 C°O.l POIt11l'.ftl>.i M*'
If2VINF, CA 92714
"IE Oil RFrAO , Qf'A I.L'C TI0N AT 110A. WWST
calSTO-M,CONSTRUCTI 0N 3441.0 H1H
PORC''II/PATIO '519.005F
UARAOMARPOR'I' SI33.44 ;3:1
ESTIMATED COST OF CONSTRUC'1 i0N
286.383.40
PE'i{i4 IFI k'i+E SVINMSRV
C,'tat3S'I`RIXTION FEE 101-Ofin-4!# OM 3 i,294.f1(1
PLAN CNEC'i FM 101-000-439-3.18 $1,0%_ 921
11 V,di"ICA1,.RM l.ii.i-000-iffl-ow $a24.00
. .
afiC TRIOAL.M. 101<M-420-000
PLUMB NO TFEE R11 -000 -4119 -OW S::U25
S'i.ONO IwiO'1ION FEE-.REST,0 . 101-000-241-000
ORADINO FM7 '
�± y y /101,-t/�((lfl�-42x3-O�00 [$20./00
��MLRIifJ'RR•f 4.R UREFRE 225 -000 -443 -?A2 K000. 0
ART 1NPUR—LIC I-AC#?3 WE SW 701 -00M_555-MID X55.96'
LQi+iSTt 1 Ci7Ci9t' i) PLANCHEC.Li
V.102.37
LESS .PRE -PAS FTI�XS
$0.00
17Z
D A'afAts PER1#ti'1. FLOU-N11 E NOW .
JUL2'`6�=1996
$9,392.37
,...
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
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath p
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enciosyre
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection ff 410
Encapsulation
Gas Piping
Gas Test Q
Appliances
Final
Final
Utility Notice (Gas) 74* 17
ELECTRICAL APPROVA,I S
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:
Window Covering Order Form
PGA West "
Buyer Name Lot # Close Date: Today's Dat
. N - `Z- 281So 2 z/ 97
Address Day Phone: Eve. Phone
5764-1.
Heritage Plan 3
All horizontal blinds used on sliders are priced as 2 on 1 headrail.
Verticals are including matching standard valance.
Room
Width
Size
Length
Dealer
Retail
Carousel
Dealer
Retail
2" Wood
Dealer
Retail
3" Wood
Dealer
Retail
PVC Vertical
Dealer Dealer
Retail Retail IB/OB Color
F/I Vertical Selection
1
Living Room (Doors)
24
X
84
$132 ,
$134
$195
$83
$146
--2-.
Living Room (Doors):
24
X
84
$132
$134
$195
$83
$146
{ 3
Living Room (Doors)
24
X
84
$132
$134
$195
$83
$146
14
Living Room (Doors)
24
X
84
$132
$134
$195
$83
$146
! 5
Family Room;
95
X
87
$416
$463
$800
$243
$445
6
Family Room
47
X
87
$229
$239
$354
$122
$219
7
Family Room'
47
X
87
$229
$239
$354
$122
$219
«0
Laundry
34
X
34
$111
$108
$155
$75
$112
I 8
Kitchen
57
X
59
$208
;$225 s
$333
$128
$205
9
Kitchen
57
X
59
$208
$225 -
$333
$128
$205
t 10_
Kitchen
58
X
59
$208
$225
$333
$129
$206
11
Nook (Slider)
103
X
100
$552
$525
$979
$280
$530
112
Nook
23
X
87
$137
$140
$204
$87
$145
13
Nook
23
X
87
$137
$140
$2,04
$87
$145
14
Nook (Slider)
79
X
100
$441
$515 ;
$769
$215
$408
15
Master Bedroom
47
X
87
$229
$239
$354
$122
$219
16
,Master Bedroom (slider)
103
X
100
$552
$525 I
$979
$280
$530
17
Master Bedroom
47
X
87
$229
$239:
$354
$122
$219
18
Master Bath
60
X
72
$235
$266
$396
$137
$228
' 9
Master Bath
34
X
21
$111
$93
$141
$75
$112
2.0
Bedroom 2
59
1 X
59
$208
$225
$333
$129
$206
21
Bedroom 2
70
X
59
$242
$266
$394
$152
$248
22
1 Bath 3
29
X
29
$101
$78
$117
$73
$110
2.3
IGuest Bedroom (door)
27
X
84
$153
1$154
$227
$85
$147
24
Guest Bedroom (door)
27
X
84
$153 -
$154
$227
$85
$147
25
Guest Bedroom (door)
27
X
84
$153
$154
$227
$85
$147
26
Guest Bath
35
X
59
$143
� $147
$214
$80
$126
err ane
All horizontal blinds used on sliders are priced as 2 on 1 headrail.
Verticals are including matching standard valance.
.._.._V.-r..-..i..�.-rw.__�.....-�.._......�.............:.._....�.—........_....,.. _.._.._.__...�....... ...........—... .. ..... .. _. ._. .. ..__........ ..._.._...... ... .... .._ ..�...v_�—..aa.�.`..,a ....�.. .Y'11dl�SC.4i1LJ1Ai. .
LA
N. THREE NAME
JL
LOT/TRACT 2 - 2
t
WTNnnWS ADDR
5 "7 611- l �iV�zL'/fin/
3441 square feet
4 bedrooms
4-1/2 baths
Family room
2 -car garage with
golf cart space
Plan 3BR J�
Preliminary
Design 1
information, renderings and maps are an
rIST'S CONCEPTION for the sole purpose
husirating possible development of the
lerties depicted. All plans are subject to
-age without notice, and actual development
i olhenoise differ from that depicted or may
be accomplished. Development not depicted
be commenced in the future. KSL Land II
es no warranties or representations of any
I or character, expressed or implied, with
ect to the natters depicted or covered.
nberships in the private golf chub facililics
`-eing sold at the pleasure of the golf course
cr sepnrately from the purchase of residential
,erty.
developer may change hone design,
rials, features, methods of construction and
,without prior notice. Maps, floor plans and
arcs not necessarily to scale.
1n V
v^/l' r
40
J6
•p:
al
114
E+
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,
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: 57-641 INTERLACHEN
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9605-138
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: R-3
Owner of Building: KSL LAND 11
Building Official
Address: 56-140 PGA BLVD
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 2/21/97
POST IN A CONSPICUOUS PLACE