9801-143 (SFD)LICENSED CONTRACTOR DECLARATION
(,.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
7A-42,93 11.31N9
Date Signature of Contractor f
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.
(Y� 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 Policy No.
WRICR IMIJ. w(.1
VC 61938M W
(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 rovisions of Section 3700 of the Labor
Code, I shall fo hwith comply with those provisions.
y�Date: '� / tw Applicant i� 4! E
Warning: Failure to secure Workers' Compensation coverage nlawful 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
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
correc4. I agree to comply with all City, and State laws relating to the building
construction, and hereby tautau h`o`ize represen�atives of this City to enter upon
the above-mentioned property for inspection purposes.
V.Signature (Owner/Agent)
BUILDINGPERMIT PERMT# °DNTRDL#
19�-`143 ,�`'/ ! 5
DATE VALUATION LOT TRACT
JOB SITEI
ADDRESS 57-593INTER1,ACdiE+�?+1'
APN
761-472,014
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KS1.1 LAND) III
S;"920 K'slk BLVD
X5920 PGA £31.N.D
1.A.Qtb.4i�"I-A CA 92 731
LA QUINT1V (.A 92251
USE OF PERMIT
S.l113
'
LOT iii, RVTfAt r�LA7N 1_Ak PETUET T)1 ,ES NOT ir7��i.�i�� .�3L+ }t iC. Nkfiu, S
fi T�t3UL A I i•
FER
o 2 1998
Ct3M-0111CONSTRUC1.'tC_3jd ,1tlt.fl4 i
GARWIRICA�RPM11'
LA !sm�i�
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t.I~C3 T1.IC,+lt,1 101 -Q00-420-W1 &143.76
PLUMBING, FIT. 101 -000 -410 -OW
;,;T4z1yiOTION FEE - TitZO M -POP-241 ^1'tbO $17 f rt.
VMW
! (1€�41Y[ 'sl,1CMR21r.1 EE 225••43004' 413-342 $.3.963.04
AWV IN PUBLM'' 1't.ACH"S -• HEM 70,1-000-255-000
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y`e}i
LESS ,;1i T.�1
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�, s 263,36
RECEIPT
DATE
BY 1
DA
INSPECTOR
I If
k
t"
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
--13 - Y �
Exhaust Fans
O.K to Wrap
-
F.A.U.
Framing
_
7a — ��
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
- a =�� _, z,
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 APPROVALS
Gas Test
Electric Final
Waste Lines
2
Heater Final
Water Piping
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:
Y
'Alex's
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
.Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Uftity Notice (Perm)
Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext. 235
MITIGATION
This Boz For District Use Only
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: Ryder Col 1 ecti on - Plan I Date: January 29. 1999
Owner's Name:q KSL LAND III Phone No. 564-7166
Address: 57Rla3r Interlachen, La Ouinta, CA 92253
Project Description: Dwelling,,
APN:
Type of Development: Residential X
Total Square Feet
Lot #:
Commercial
Area: 2,101�T'
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/she is
Dated:Oq�&—Signal
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE):
Gov. Code Gov. Code Project Agreement Existing
53080/65995 65970 Approval prior to 1/1/87
i
Note:
Number of Sq./Ft. 2,101 Mitigation
Amount per Sq/Ft. $
Amount Collected $ 7,200-00
By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcel a Valdez Signature:
Facilit,iesCClerk
Not subject to fee
requirement.
NOTICE: Section 66020 of the Govenunent Code enacted as Assembly Bill 3081, set forth as Chapter 549, Statutes of flee State of Celifomia,19% effective Jan. 1, 1997, requires that this school d ct vole a written notice to
the project applicant at the true of payment of school fees, mitigation payment or other exactions. This notice is to advise you that any protest bm regard to such amounts or the validity thereof in acco ice with Section 6ti020
of the Govenuneit Code and other applicable law, commences with such payment or perforuance of any other requirement as described m Section 66D20 of floe Government Code. Additionally, this notice advises that the
protest timereof must occur wilhhn 90 calendar days timereaRer.
Note: AB 2926 and SB 201 fees are capped at $1.84 per square foot for all residential construction, and at $0.30
per square foot for commercial/industrial projects.
Dev. Fees Disk: Misc\Ceti-Com.Sam (REV. 1/97)
DEVELOPER FEES PAID
AREA:
AMOUNT: $
RCPT.#:
CK. #:
CASH:
DVITIALS:
DATE:
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: Ryder Col 1 ecti on - Plan I Date: January 29. 1999
Owner's Name:q KSL LAND III Phone No. 564-7166
Address: 57Rla3r Interlachen, La Ouinta, CA 92253
Project Description: Dwelling,,
APN:
Type of Development: Residential X
Total Square Feet
Lot #:
Commercial
Area: 2,101�T'
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/she is
Dated:Oq�&—Signal
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE):
Gov. Code Gov. Code Project Agreement Existing
53080/65995 65970 Approval prior to 1/1/87
i
Note:
Number of Sq./Ft. 2,101 Mitigation
Amount per Sq/Ft. $
Amount Collected $ 7,200-00
By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcel a Valdez Signature:
Facilit,iesCClerk
Not subject to fee
requirement.
NOTICE: Section 66020 of the Govenunent Code enacted as Assembly Bill 3081, set forth as Chapter 549, Statutes of flee State of Celifomia,19% effective Jan. 1, 1997, requires that this school d ct vole a written notice to
the project applicant at the true of payment of school fees, mitigation payment or other exactions. This notice is to advise you that any protest bm regard to such amounts or the validity thereof in acco ice with Section 6ti020
of the Govenuneit Code and other applicable law, commences with such payment or perforuance of any other requirement as described m Section 66D20 of floe Government Code. Additionally, this notice advises that the
protest timereof must occur wilhhn 90 calendar days timereaRer.
Note: AB 2926 and SB 201 fees are capped at $1.84 per square foot for all residential construction, and at $0.30
per square foot for commercial/industrial projects.
Dev. Fees Disk: Misc\Ceti-Com.Sam (REV. 1/97)
Certificate of Occupancy
City of La Quinta Building'and Safety Department ..... OF,.��°``v
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: 57-953 INTERLACHEN
Use Classification: SFD
Occupancy Group: R 3 Type of Construction:
Owner of Building: KSL LAND III
Building Official
VN
Bldg. Permit No.: 9801-143
Land Use Zone: 'RL
Address: 55-920 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 8-5-98
POST IN A CONSPICUOUS PLACE