9602-076 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
7000) of Division 3 of the Business and Professionals Code, And my
I.— t
License is in full force and effect;�,, 59/515 limq p
Y. Exp'. Date
Ucense#"- LIC. Cl P 71411
,
Date(,�. 'Of�� ;
Signatureof Contractor�
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
1, 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).
O 1, as owner,, of the property, am exclusively contracting with'Ilcensed
contractors to construct the, p I r6ject (Sec. 7044 . 13Ssiness. & Profession'als'Code).
O I am exempt unde�'6eaioh;'' B&R.C. for this reason
Date ",Signature,of Owner
WORKER',S-,-COMPENSATION'6ECLARATION
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, -ai,prov;deZl-6r,*6y Section 3.7W.,of the Labor Code, for the
performance of this work f6r_ 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 sectId-hjde—ecHLi6,M5e completed if the permit valua1:idKi.4ok$)k00!00 or less).
I certify that in the performance of the work for which this permit is issued,
.1 shall not employ any peison 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 woryers' compensation'providonsr of Section 3700 off the Labor
Code, I shal(fordi(vt6comply.-g�iVi4bop*,/ "pTpyi.diob.. — ./
in. /- , - c,44—
Warning:
Warnlhg: Fail6re 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
in permit issued as a resuk oftKiiiU. plication agrees to, & shall,
y p indemnify
It. L_ � ".., I A-
& hold harmless the City of IIh!Nan-WefIS,1ts 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 cancellatiorI.
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 purposes.
_Iignature° (Owner/Agent) 'Date .16 ,
ALCM
_BUILDING PERMIT
-1. P . ERM"An-ou
V"
DATE r is
VALUATION
LOT TRACT 40M 14Y
JOB SITE ADDRESSAPN
\54-795 WINGED FOOT
5(w -
76 94 45,,
OWNER
CONTRACTOR,
.,RANCHO CAP,'(,,S-fRANO,DP-VFIlopi�4U.�
K S L17 LA N D
70187 C OUNTRY CLU11.3'.DR. 020,
56-140PGA',BLVO.�`t'--
LICE RMUDA DUNES CA 92201
E�� 6U"IN'TkJC, 9`9 2-:2,_.5'.3"7..
(60,0)'3445-1755 MILO' 1.� 6�
DE SIGNER/ENGINEER
CYP IN .RKAT1()NAJ�
'(619) .564-1 0$$
1.7992 t'k41TCk—wLL SOUTH
USE OF
MaWCA (7141661-0970
C<AA.LJ-.Cf ICAN kl' 1'GA WEAT'r PHAM, I
FEE DESCRIPTION
FEES"
CUS'YOM CONSTRUCXtO'K •2
PORCY-UMT10 Iii
(MRAGE/C.ARPOWr 527,00 3r
ti
FSTIMATED COST OF COINYMUCTION
204.,442.70
PERMIT'FrE.0 SUMMARY
PLAN (1-TECKTUB, $823,27
CONST RWCION FEE 1,01-000-4118-000
MECH ANICAL FM $92.00
013C'YRICA1, FFF 161-000-420-000 $153.719
STONG MOTION FEE - IMSID 101-000-2741-000 $20.44
MADING M- 101-000423-000
INFRASTRUCTME FEE 225-000-441-342 $4,526.64
MRT INPUBLIC PLAq.335'._.RESID 70'1-000-255-000
43=40TAL CONISTRUC310IN AND PLAN CHECK
13 SS PRE -PAID FEES.10.00.
'1'7t07 30
PEMUT FEENDUE NOW$7,
FES'
5
07,11. 0
RECEIPT_
I DATE.
JDATE FINALED
INSPECTOR
- FIA
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade "LP7
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
01
O.K. to Wrap 196
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 AM
Final
Final
BLOCKWALL A • PROVAL
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
Shover 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 --
Y.,
Citv of La Ouinta
Building and Safety Departin Ht �MoF-
This Certificate issued pursuant -to the requirements of Section 109 of the Uniform Bq#ding 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: 54-795 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No..: 9602-076
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: R-3
Owner of Building: KSL LAND II Address: 56-140 PGA BLVD, CA., 92253
City: LA QUINTA, CA.; 92253
By: DANIEL P. CRAWFORD JR.
Dater :3/27/97
Building Official`
' POST IN A CONSPICUOUS PLACE