9605-134 (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
N ; 'Professionals Code, and my License is in full force and effect.
O Z) M License # Lic. Class .�^ Exp. Date
Z Date , Signature of Contractor
(DON
J U S 0) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C'`) () I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
ON
rn
d Q WORKER'S COMPENSATION DECLARATION
p cr I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 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 J Q performance of the work for which this permit is issued.
m Q V ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the -work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
`t z Carrier s'l°A'1` [ t1Nl:> Policy No. `ysyFii3v371
ob:D
C)
Q (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 and -agree that if I should become
3 subject to the workers' compensation,prov California,ons of Section 3700 of the Labor
Code, I shall forthwith comply with-'os
provisions......
Date: ! Applicant __�� ._
A`
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit'to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, md'State laws relating to the building
construction, and hereby autho,Gize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
9
Signature (Owner/Agent) Date7,14
t°
BUILDING PERMIT PERMIT# CONTROL#
� 3463
DATE VALUATION LOT TRACT-
�-y 5 04444�V O !Il k�i.1et PH 41
JOB SITE
ADDRESS :i.�9fi b� IiVi;l+) l+dKti` APN 76459-0
i
OWNER CONTRACTOR/DESIGNER/ ENGINEER
4S
LA QUINTA
USE OF PERMIT
t'ol"JN'TK1' t'w 1)R #201
f:'A 022`+3 BERMUDA I:)1.1P$N CA. 92201
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(.'100 t'(?M: t,'OWNTKt.Ie..' iof.i
t'OR(` tipK('10
0ARA(SWCARPORT
2,4 Sii.(10 S'F
15.00 SF
527.00 8F
VII TED CXAT OF CONTSTRIU .rrON
204,442.70
PIKI'`MIT IFFIF, S'{TN2MARY
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225-MM0443 _M2
$4,526.64
AWA IN P(J.WC PT, WE$ - Edis"?t.f.". 701000 -?5544.
$261.31
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F1,T3 t�'aL �"i'1 �'C.� IC 1 X1.'111) P" AN C111—�° $7,{171..50
1.AISS PU-,1'Af1J FEES $0.00
JUL 26 1996 _1 . .PF.RAHT FOES DUE N08V s7,137MR)
RECEIPT DATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings o,
Ducts
Slab Grade 2FI&
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap G
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 APPROV S
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 Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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:
i(Clprtifica te- of O
ccupancy
Cityy of La Uinta F
Building and Safety Department 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: 54-415 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING -Bldg. Permit No.: 9605-1341 -
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