9602-081 (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. 597975 $/7131;9677
License # I Lic. Class Exp. Date f
Date .. r / Ih SignatureofContracto, 41 11, !• •r "M .1
OWNER -BUILDER DECLARATION f/
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
( ) I am exempt under Section , B&P.d for this reason
Date Signature of Owner
WohkER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and wip,maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This sectj9p;Dp9 4rtigt p completed if the permit valuatiorlrI fQr($_W.90 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;Section 3700 of the Labor
Code, I s"I forthwith comply w,j those provisions..,
..
Date: I.�/ i Applicant'' t :Ni/ i( Fr /Ir/fl 11�
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 application agrees to, & shall, indemnify
& hold harmless the City ofiiAbiah VHA g' -i' 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 inspe6on purposes.
Signature (Owner/Ager( \fly// F�-4f!/•J// Dats/'/ rI
ALCM
�
~ -BUILDING PERMIT
PERM IT,%4)Z_08.I
DATE j u
VALUATION C ti i �`
LOT f TRACT' 'ie
JOB SITE ADDRESS �(,95 W1N{rF,
APN 769450-045
OWNER
CONTRACTOR
RANCHO CAPS5T'1tAN0 DEVELOPME1 ,
KSL LAND 11
741687 COUNTRY CLUR DR #20
56-140 PGA BLVD.
BERA11JDADUNIS CA. 92201
LA QUINTA, CA 92253
(619'0455-7755 C801060
DESIGCE PI IMNTRRNATIONA
(619) 564-1088
USE OF PERMI > 1 (,1 ,H ,'J 1N111.1 iJW[i1.1LI?4ki
17,9921'NUTC1'��I ,SOUTII
/1y
`1'M, XYDf-X CO LLF ON AT POA. WI .ST PlfAS3;1
PLAN 2-Al2
FEE DESCRIPTION FEES
Cil.NK)i1V1 CONSiTRUC71€0tv '4379.00 :S.
PORC€€fFA IO 202A0 S1:
f1At2Af3FICAk4'OR 1' CiZ?.CIO SP
FST TRATED COST Of CONI STRUCHON
200,201.941
PKRj tT FRF, SUMMARY
PLAN C PECK FEE ! �1 •{)(}11-.t��1.� l it �K I F, yi
CONSTRUCrIONFER 101-000-418-000 $9100
MECHANICAL FEE- 101-000-1121-000 $98.30
I-JXC l'X€C" At, l•'EE 101-000-420-000 $153.21
}''t,(T;K4 i1N0 f: F 1014)00-319-000 S 17.1. 2 i
STOW MOTION F€% -1t1'. D 101-000-2.41-000 320.02
(11MANG I<E[ . 101-000-42.".,-000 5'x'0.00
1NFR A8'YRUt_" t'UkU1. Me' 72.5-000-443-3,12 54.444.(10
AR!r iN t,t,o IC �,f,Acrts -1 vswo '701-O(n-2{5-om- S2`O. ut
r = ' " 1'; TRUC"I30N AND PLAIN CHECK
$6,968.81
p LESS PRE -PAID PEES
$0.00
O
TO i . PERMIT FEES U1.3,1dOW
FEB 21
$6,963.81
199
By
[RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs L
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing 4aa&
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 APPROVALS
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:
Certificate ''of Occupancy
City of.L& 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: 54-695 WINGED.FOOT
Use Classification: SFD Bldg. Permit No.: 9602-081
Occupancy Group: R-1 Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND II CORP. Address: 54-140 PGA BLVD.
City: LA QUINTA, CA 92253
Building Official
By: RICHARD KIRKLAND
Date: 4/16/97
POST IN A CONSPICUOUS PLACE
I
a
_ CITY OF LA QUINTA
w a BUILDING & SAFETY DEPARTMENT
UINTA ma012
INSPECTION REQUEST LINE
FEB 211996 m-7153 -
Owner�ICAPISTRANO DEVELOPMENT
ContractorRANCHO CAPISTRANO DEVELOPMENT
9602-081
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
'JOB ADDRESS 54-69.5 WINGED FOOT .
SING E FAMILY DWELLING PHASE I PLAN 2 AJ
7 -2- - ArZ- _
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
PRE-GUNITE , 1 T
DO NOT POUR CONCRETE UNTIL ALL AB VE HAA REEN sIc;NFn
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF - c
COVER NO WORK UNTIL ABOVE hI4S IPEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL F=ENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
TEMP POWER
errs : ? q. y AlTow
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
I /95 TURN ON UTILITIES OR OCCUPY BUILDING