9602-075 (SFD)LICENSED CONTRACTOR DECLARATIOPI.,�
I.h"y 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 37/31/96, '
License # Lic. Class /17 E -- Date.`
Signatureofl,ontractor
OWNER -BUILDER DE LARATION
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, wrier
.,.'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.
S (This seotj9lir9.VtdrW"0v completed if the permit valuation00 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 I should become
subject to the workers' comperes. on provisions of�Section j3700 a Lsbor
—Code. I .shall fdrthwith.cbmo14 with those�`crovisions..li ! d
Warning: Failure to secure Workers' Corripensa°tifo`n-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 applicafion...
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 t6;
any permit issued as a result Ij'of,thls application agrees to, & shall, indemnify
& hold harmless the CityofJFrdan Wells;`dsoffcers, 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 inspe/ction purpjoses. ,J//% J{,/.
f f Aka
� S gnature (Owner/Agent)HL
T; Date t':e� . ,�
ALC 'BUILDING
PERMIT - PERM ITWZ.0 5 1
DATE - .411.)1700
VALUATION •'.o IV-1.1y4-10
LOT L1 TRACT. . v. 1 :,
JO&SITE ADDRESS S�INC,F
APN
t
1.76". -045
OWNER
CONTRACTOR 1 `p� ��yy AA rr',qqcc 77�qp� � y,�+ AA �7
MINC.1.104A'+�s.[,V�l3F.!\�NO.DBVFLOI�MF.
K S L- LAND 11; 1
-.
7-0687 'CC)Ul�°Citi' CLUB DR 020
56-140°PGA BLVD
f31 ltl�f(3.')ADUNES Ch 92241
W CA 92253
(61 9)345.7755 BT,l>? 1.969
LXQUINTA,
DESIGNERtENGINEERYp INS BRNK tONAL .
(619);,564-1, 0 8 8,
y
17992 MITCd3 tL S011YR
USE OF PERMIT. JSu: ° FANTILTDW-011INU
I Viir' _0,,A (9D�ilrL&D-0470
FiC Rlr! lix C c I t M'I0'N ;1; P0A: WEST :P:HASS A -
PL.t N' .i -C: , �J
FEE DESCRIPTION
FEES
C Q9170.1\4 CONSTRUCTION ION 2, I0t.00 SV
PciRCHIPA O 230.00 S.
G.4tAQFJC'AJ2P( Wl., 6361.00 SI' �
V Y,;
r
Fs'.rWA'IjJ-D COST OF C ONXI-R.UC."fcIONt
17?D,19.2;50 .
PERMIT VIM SUM.tVlEltdY
PJN3 s c tt, C ,Ff; 10 t-000-4.1,97'41. $ `? :85
C,GIVSTRT1C1102�1IZEE; 1.01-000-4tivoo10 sg14:50
N1 t k4klQCAL t 1df3+ 101-000-421-000 - V9.00
a
BLE .11RI ?AL:.F M 1:01-040-420-000 �l.41.76
_�s,IJ?+ Orl�c�•: 109.-000,419-000 S16725. .'
' 'TONG MOTION �;iD 101-000-2AI-000 .3J.7.92,,'
�ORAY)DNO.1%Li'i;/ 1.G f-CtOfi442-tit�tl S2tl.t�0
1Dd1: €2 V.S" RlJCiYUR1,r Nt`s : 225-000-443-312. 5;.9C►3.o0
AR'.V, j'N i'L3:13T Ire rN�A ` � 1 . ":11 '71,1 -000-21. 54.1100
SUB -TOTAL CC9NS'I RUCTIO► 7 AND .ISL AN L1- BCK
$6..263.36
LESS 1'£t1�-PATI? FUS
x+0.00
gyfm', J.'mmll l L' 0.s MTE NV 7'Y '•
•.
_ rt e
. ,yig�p4a3::Y'4l
FEB�2,.1..
1996
f
RECEIPT —• —DATE
_
4
BV
DATE RNALED
..
INSPECTOR
'1�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
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 3/
Final
Final
POOLS - SPAS
BLOCKWALL APk(O/AiS
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
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)
, .Certifca to of Occup
ancY-
.�.
a
Cityof LaQuintal
J
�MOW
.Building and,. Safety Department O
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: 54-815 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9602-075
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: MARCH 17, 1997
Building Official
POST IN A CONSPICUOUS PLACE ■