9605-127 (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
i 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
WUHKER'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 .i'1'Ayl` F'11zV1) Policy No.
(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, A.;ovisl nos of Section 3700 of the Labor
Code,,j-s ifJoAhwith comply with fiose pr visioPs;
Date: Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Comperfsation 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���nd State laws relating to the building
construction, and hereby autheerdpresentatives of this City to enter upon
the above-mentioned property for Inspection purposes.
Signature (Owner/Agent) .` a<f Date
BUILDING PERMIT
PERMI4# CONTROL#
.�� ,� 3453
DATE VALUATION � � .� � LOT
_
TRACTJOB
S1 I E
ADDRESS .9 •:. SS W I[NG�°b �! 1
APN %1��^4��I1���65
OV
CONTRACTOR/DESIGNER/ENGINEER
KSL LAND II
►, ��1�;.[;t3 s �,;:;;�,"7t) I�t1'tt.c:.F'SF
56-140 PGA BLVD.
('0UNTICY= CLUB 1rICfMl
LA QUINTA, CA 92253,,;
BVRN4!JOA DUNF'S ('A 92201
(619) 564-1088
I619434�-77s's � f�i31,�t 1W
USE OF PERMIT
+,13= IINTI-RiNtiMINAL
:�{f�tir1.F�, j�'AAi.It,Y 1,jiNHj.t,ll+)tj
} ��:Y'2 �1l'i'L`'Ht?.1�1. ti()ly`f'ti
x.
TKVI 3h, (-,A l7' I4
T3lti Ityll �R C0LI,K,7 A.-) l xr P JA kvcsT
PLAIN AAR
4 J%'i'0Nt f"('i'NSTRU1010N 1.44f).tlfl SF
KYP,VH/1+A,TI1 2.15AN)
Sl<;
0ARAffFICA:RPt 111 1.1a7,00 8F
ESTIMATED COST OF CONSTRUCTION
204,442.70
PERAIJI ' Ei`E SIfAII11[AR
PIANCW-Cy. 11101
$Vl 17
CONST2i.Y030NVIX 101-000-41.9-0013
51,007,00
f tt d tiANICAL F4 1 -'E 101-000-421-0W
s921 00
11 f C7rRICAf.I*W; 100.-000460-000
$153 79
t�"rt rlyv Ib10110N .1 - RESUD 101-000-241-000
Sett, t4
OtRt\djlNO VEE 104-000-423-004
�2tf.t►tt
lNKI AhKf.RXX'1Vftk FFYF 225-000.443-342
S4,526.0554
AJJJ' IN Pt�WI, <' Pi.n<:'CR - RJ? SII' 701-(ICfO-�.SS-ntifl
fif 12 -MIA 1,r'�f LTMIION AND PLAN CITECK
$7,071.10
LESS n.0 vivu "ROES�
ID 11 'I, PE1fdNUT F Ilii?S DUk' NOW
tetl.W
$7,071.50
JUL 26 1996
By
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
r OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
t7
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 2
BLOCKWALL APPROV S
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
9 79y
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:
2.
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: 54-555 WINGED FOOT
Use Classification:' SINGLE FAMILY DWELLING Bldg. Permit No.: 9605-127
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: 3/12/97
Building Official
{0 POST IN A CONSPICUOUS PLACE