9602-082 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 39;97i B/ . 7;1 i+�
License # / % Lia Classy ;' Exp. Date
Date " . l r �* SignatureofContractor�
OWNER -BUILDER DECLARATION
I hereby affirm 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.
( ) 1 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.
(This sectl6n4,Wdii6tbe completed if the permit valuation' s-foi($100100 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 provisions of'Sectyon 3700 of the Labor
Code, I shall' forthwith comply w'tK'fligse'provisions. %
Date: �,/'.', I �Y'Applicant�1l
% r
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 thislapplication agrees to, & shall, indemnify
& hold harmless the City of Indian -Wells, 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
11
above-mentioned property for inspection purposes.
i
Signature (Owner/Agerrtr Yi Date / +�
ALC9
-,___B.UILDING
PERMIT
PERMITImm
DATE ®
VALUATION 0# + + LOT `'
TRACT J, 1
JOB SITE ADDRESS 7NGD
APN 769-450-0$5
OWNER
CONTRACTOR
R ANC140 CA PI.y-'i'1t ANO DE YF_LOPMET,
KSL LAND 11
7008?COUNTRY CLUB DR#20
56-140 PGA BLVD.
BERMUDA WNES CA 93201
LA QUINTA, CA 92253
(619)34:5-7755 Cb).# 1969
DESIGNER/ENGINEER
CYP TNM, NATIONAL
(619) 564-1088
17?9iMITCHbIL KKMI
USEOFPERMITiI Q A, 1't 1'1' 1 r 1.1 :I: ,L %VCI
if<i4'INF.I�./A 7it►fiail),.110'70
' Hit, KYDEN CCN LE;C HON AI' K A WK13T PILUE i
PLAN 1-A
FEE DESCRIPTION
FEES
C',,ilSTt)M G(JNSi'kE,ti."I'iC)N 2.101.11() ;!}r
PORC"ATIO 230,00 SIT
GARA(MC;ARPORT 636.00 SF
ESTIMATED COSH' OF CONSTRUCTION
PEITI iff FEF: SUMMARY
Pi , AN (^IVF ('K F F V 1101 -ON -430-119 $754.95
C ONSTi'tIXTION Fly 101 -M -4I$-000 $919.50
iv -C HANICAL FEE 101.000-421-e?CcG $79.01+
IXECI'RICAL .FM 101-000-420-000 $143.76
€'T:1%ffiW_ FrI.F I01 -(M-419-000 $I057.25
STONG MOTION FES - RLSID 101-000-2.11-000
GRADING Fid 101.-)00-42'3-000 $20.(10
INFRXSTRI[R WRE FEE 225-000-443-342 33.463.W
MRT iN PT1I3I.,IC'!'T.k(T .8 - PE41.I; 701-tNN?-2SS-(1(}U $)9'1.98
SUIS-TDTAL CONSIRUC 170N AND PLAN CHECK
$6a63.36
LESS PILE -PAID FEES
n
$0.010
0
i D UTO ILPERMIT FEES DUE NOW
$6,263.36
FEB 21 1996
�r
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I A
Ducts
Forms & Footings
p,Underground
Ducts
Slab Grade
ZjZl 7A i
Return Air
Steel
Combustion Air
Roof Deck
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
41
Final
Final
BLOCKWALL APPROW LS
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
Saver 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:
r ifi -of Occu-
p,ancy..
Ce t cate
.y Cit of La. Quin'ta's
Building and Safety Department OF T�
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.: 54-675 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9602-082
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
- Dater 4/11/97'
Building Official
POST IN A CONSPICUOUS PLACE
,,
r ifi -of Occu-
p,ancy..
Ce t cate
.y Cit of La. Quin'ta's
Building and Safety Department OF T�
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.: 54-675 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9602-082
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
- Dater 4/11/97'
Building Official
POST IN A CONSPICUOUS PLACE