9605-135 (SFD)LIGtNJtU GUN I KAG I Uri ULULAKAI IUN
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
Date � " Signature of Contractor _4
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 t4 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
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.
a i 1: i- uN%i 2 9-41)mnt 111
(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,provislons of Section 3700 of the Labor
Code, I shalltforthwith comply with those provisions.
Date: Z /2 C 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, 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
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. y
Signature (Owner/Agent) fr,: i ,�l °/.. Date 2/;74;, le-�,
O
BUILDING PERMIT
PERMTk �---�'---�-�--�°NTR°`"�Y
.�
3556
DATE VALUATION LOT
` 11,^
TRACT
JOB SITE'T
APN
ADDRESS 4-151.15'W iNG01 T) . OOT
769430-0145
OWNER CONTRACTOR / DESIGNER / ENGINEER
'ST,.JIAt 40 ft
Rik?IC.flO("APIFi1`"E2ANO I)EVI't.CjlIN
-,504 40 PQA BLVD
79(i87 CUUNTRY, CLUB DR #201
L A,QUINTA. (1A 02 -51
BERMUDA DI.;Ro1E4' CA. 92101
f{sib ifit�lfl it
f�Cii9) 1 77.55 CBI,# 11460
USE OF PERMIT
CM 1N r6R Xr10*Z4A1.
lRVINIF,, CA 92714
THE Rt°U R C aTA.FC" 'I0N AT PGA WEST
PLAN "-Co
i.' 181'(4vt C:O sTIRI►C TION 449.00 NY
.F' j ICI VPX1110 202 tul `,_F
C ARAGR 'ARKIRT 822.00
S111
._l
f';STit1IA'!VD CaST 01' C'ON cTRUC"fWN
PERMIT ITTllttlAWfARY
101, lif)fldc;`; _';1
',,
t ONSVI It1.N"'I40N Ff'# IOI 000-'113•fI00
VJJ,. <11AN[k.;AL Rih, 10140 -421 -OW
101-Ot![-420-000
W;.21
1>( I tRdll l l�+f I l itf: I ft1-il()0_4 19-000
8 711 `? 5
o1`iC'101 000-241000
�2tj.tY
F �[�t�lal [4ts t� fala T U i •(Ii1Cr-�2?-0(fi+
�2(f_tni
sNl•I�Ra i°lttr� ai`t ltl,l`E;f: ?2 S- 00143-40,
54,444.09
ART 114 INtill 1C Pi,ACI-3 - ,RW;lt". 701 -Ott(- Ki-f1I10
X150 4(t
81 D1 1'AAL CONS'IROC.`I'dON AND PLAN CI IECK
n LESSPRE-PAID FF -ES
F>tMy
D
JUL 2 6 1996. ;
RECEIPT QY
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap d
F.A.U.
Framing Q
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wail 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 Plbg. Test
Final
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
'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)
to of -'Occupancy --.T
Cert�f ca
Ciof La Quinta-
ty
Building and Safety, Department FM OF
.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: 54-395 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9605-135
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. CRAWFORD JR.
Date: 3/13/97
Building Official
POST IN A CONSPICUOUS PLACE
9