9602-079 (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. 591W. 3 7/ 1/%
License #I Lic. Class ' /Exp. Date '/
Date 40 SignatureofContracto � /',
OWNER -BUILDER DECLARAI II.O/N
I hereby affirm that I am exempt from the Contractor's"License Law for the
following reason: I ..
( ) 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).
O 1 am exempt under Section' B&P.C. for this reason
Date Signatureof Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
O 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 Policy No.
(This sectionjn"-,ctr19ttl a completed if the permit valuatic n s.kr4$1iWl 0 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 S�ctlon 3700 orae Labor
Code, I shall fort iwi comply w}'trtt1l;A/
rovislons.��
Date: f,a >( t� Appli f X• ' fi^Nor9�/J 1
77
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for. in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT. Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is perfomed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of lndi 'hn-%" -eAs 4^officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I'certify that I have read this application.and state that the above information is
correct. I agree to comply with all ,City, and State laws relating to the building
construction, and hereby authorize representatives of, this City to enter upon the
above-mentioned property for inspection?purpo.ses.
d.
Signature (Owner/Agent) l i%`%/ '' / F f l t/:;l Dais /A//r•/
ALC '..BUILDING
PE.RMIT•.
" ...Ts �i
4
DATE
VALUATION ' ~'Y +� •'x�
LOT TRACT;
JOB SITE ADDRESS
TPN 769-450-045
OWNER ___:,
CONTRACTOR
RANC O Ct#PIS' `RANO DF31 EA',ORNIEn
K S L LAND 11
79687 CC,C:TF'M:Y CLUB DR 020 .
56_-140 PGA BLVD.'-.-!
131vfL&IC[DADUNES . CA 92201
LA QUINTA,.CA 92253•'
(,ti19)345-7755 CB14 1069
DESIGNERIENGINEER
GYP lNTERN.ATTO yx
17992 SOUTIT
(61 9) 564-1088
USE OF PERwTj,LNWh. FAMILY W% a , ZJ'
YR V . •R, 0A 4`71466"410
THE :RYr)Elt COLLECTION ATPGA WEST i>HMS 1 -
fALAN I -CR
FEE DESCRIPTION
FEES
C
'I CiM C ONS'€.RIJC.'7ION 2,379.00 SF
f%C').RM$Y PATIC) 202.00 SF
0iUZA.0FJCAR}?0Xr 022,00 S
FrS`�'.iMATED COST OF CON5i'iRUC'q'ilOiN
2000.201.90,
PERMIT FEE SUMMARY
-K-4,34 C;HI:XX :�Ji 101.OM-439-318
CONSTRUCTION FF1117 101,400-418-000 $993.00
MECElKRIC,AL FEE. 0 -000-A31-u00 3913.55
1~. LEC "I'RI.CAL FEE 1.01-000-420-000 $ 153.21
Pl UM..31NC1 r'Iffil 101-000-419.000 $17, Z5
Y170i4C �a 0TIONFI - Ri•:,= 101 -000 -241 -WO
ORADING FQ 101-0001.42-1-06') ).0c►
INF'tZ.r S R1:lG'IME Fn� 225-0()t)-443-342 $4.444.09
!. T IN pMLIC PLAC1:s RE$lta 701.000-Li0
o •
• slit-rCalu c o.t mzucrioN .,,�Nz) PjdA lr sur,,ar.
'LESS PRF. -PAW FEES
OD .. 3 L PERM T.�E4+aS D� 1�1D87V .
$0.00
�G,,�+C�S�•
FEB 9J .1996
RECEIPTDATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings I
Ducts
Slab Grade 411
Return Air
Steel 1
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap &F.A.U.
Framing
Compressor
InsulationI.A—ZVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath N, K,_0_
Final
Final
POOLS - SPAS
BLOCKWALL APPROVAL9
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out r v
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
Utility Notice (Perm)
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: 547735 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING.--, Bldg. Permit No.: 9602-079
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 O.UINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: .5/21/97
-.Building Official
- POST IN A CONSPICUOUS PLACE