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9605-128 (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 Date �, ` Signature of Contractor :armor - - 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 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 sun, i. m Policy No. 229 -1J( (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' comensatiog provislons of Section 3700 of the Labor Code, I shail forthwith comply witfl hosr-e'provisions. /' J Date: Applicant -7^ f'r' --- Warni 9: Failure to secure Workers' Compxtion 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 re �resentatives of this City to enter upon the above-mentioned prope or -i s ection purposes. Signature (Owner/Agent) Oe, Date BUILDING PERMIT PERMT# °°NTR°`# c,im-us; ? 4 5 4 DATE. y VALUATION $179,'.192," 9,.1192," LOT 14. TRACR,1 [fit"0 PH c AqJOB SITE1 ADDRESS r 5435IWI tGED FOOTAPN OWN' CONTRACTOR / DESIGNER / ENGINEER KSL LAND II . A j�nLjn1-�or�ra;�Nr�►�PATQf00A4t;� 1 JtL � x..11 V \. . U..41 1, J'.J%A V ♦ I, WI, J' L I*U,ai 56-140 PGA BLVD. 79687ChUWIRYCLUB Oit.k2ol LA QUINTA, CA 92253 BERMUDA DUNES CA 42201 (b10j11405, 1755 030 1969 (619) 564-1088 USE OF PERMIT CYP 1'N'T'E12N1',VONAL SlNC.;W FAMILY DWELLNG 17992MIT'C14ELL SC?tJ'iH tTV 114H. C.A 9,4 / 0 ICHE RYUE12 CdLI,EC-r10N A.T PDX WEST 'PLAN t -C PORCH/PA rio'230.M SI C1A.RAtsFVCARP(.)Wf 636.00 off €'RUCTi ION N 5 its t ? ,i} '.isi O�� CONSTRUCTION 174,1.92.550 M, , RMIT FPB 811A MARY CHFUCK* Ff%" 101-{�f�0 439-3�"/i8 � � �5 tt!'L4NN ,$kr7�5ffay L.�I�IjSfw!T.R. C l.(AN /'.F��' 1011 -000 -418 -WO $919.:50 m1;41iAAl1 ,f i., FG -F. t01.0itf}-x#21-0 fif x�9.o© f:Tfw?f ( f'RICAL Ff3 , t01-000-420-000 $143.76 i>I;# 1" Nf31 1?l• i131,F1f3tt Ai4-fli)Q $167.25 ;.',I'tg40 A.i�7' 10Nl rrx - jwstD 101-000-2411-000 $1;.92 GRAD1NO P: til 101-o'1(`r0-423-M S20.00 .1N RX'TI'RtiL-r(iRB3FEE 2250)0.443-312 $1.963.% +1RT 114 P1113l.1C Pi Cf,'; - RENO' $197.98 SU134�31'AL COfvtS"'IRI.l -MON• �WD PLAN CREC.K,' �,2d3.3t3 k �n F 'SS PRE -PAID RES TO'TtU,' PERNIT!" FUS DUE NOW JI/ $6,M136 4 2 6 1996 ,v RECEIPT `.� DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION j DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Slab Grade Ducts Return Air Steel Combustion Air Roof Deck Q 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 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 APf ROVALS 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 A"115 zla2 4zl7w= Utility Notice (Perm) Certificate,of Occupancy Citv of La, Quinta 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 fol wing: BUILDING ADDRESS: 54-535 WINGED FOOT Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9605-128 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. T 1 Date: 7/10/97 Building Official POST IN A CONSPICUOUS PLACE