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9512-116, 9704-005 (SFD)LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with CV ? M Section 7000) of Division 3 of the Business and Professionals Code, and my rz Cy u.) License is in full force and effect. 5979,75 B 1! 1196 r- WLicense # Lic. Class Exp. Date r1_ Z n Date Signatureof Contractor fi rG 0 t` ah OWNER -BUILDER DECLARATION J U 1 hereby affirm that I am exempt from the Contractor's License Law for the I.- W following reason: (4 ( ) I, as owner of the property, or my employees with wages as their sole Z 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 N - OU rn WORKER'S COMPENSATION DECLARATION a Q I hereby affirm under penalty of perjury one of the following declarations: Z ( ) I have and will maintain a certificate of consent to self -insure for workers' �O compensation, as provided for by Section 3700 of the Labor Code, for the x W LL performance of the work for which this permit is issued. J J I have and will maintain workers' compensation insurance, as required by b Q U Se6t-i`on 3700 of the Labor Code, for the performance of the work for which this U permit is issued. My workers' compensation insurance carrier & policy no. are: 3: Carrier Policy No. Z (This secti=,T c qcompleted if the permit valuation is)foSL$;11)0.00 or less). � �() I certify that in the performance of the work for which this permit is issued, QC7 I shall not employ any person in any manner so as to become subject to the J workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor c Code, I shall forthwith comply with those provisions. Date: Applicant QWarning: 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 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. 0 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: ;Signature (Owner/Agent) rte- F� Date ��9AV ALCi BUILDING PERMIT i PERMITV.St 211,16 DATE 121 119..4 VALUATION S375, Z� TRACT '231115 JOB SITE ADDRESS 84-234 I&MI APN 761-470-1039 OWNER CONTRACTOR RANCHO CAPISI'R.ANO DEVELOP KSL LAND 1I 7W7 COUPPI'R.Y CLUB DR 920 56-110 PGA'BLVD BERMUDA DUDES CA 92201. LAC UiN!A CA. 922.53 (619)345-7755 CBL#. 196© DESIGNER/ENGINEER B B D ARCi1P1'ECTS d6 CORPORATE PARK USE OF PERMIT41NGLi,^AMIE i 1)%-ELC. NG `01rA - , 1A POA WEST - '[Rs h4AsIrL. i3 G"OLLEC TION PHASE I PLAN3-B FEE DESCRIPTION FEES CUSTOM: CONS9:RUG110N 4,542.00 LF PO.RCIUPA'r.10 715.00 SF GARAGE(CARK]IRT 811.00 SF EST.I11'iATED COST OF COT+NSTRUCTION 379,226.90 PERMIT FEE SWOMARY PLAN CK. -CK fTE 101-000-439-313 $1,312.62 CONSTRIX-FION FEE 101-000-4113.000 $1.619.50 MECHANICAL FEx 101-000-421-400 5137,00 ELECTRICALk-a1,01-000-424-000 $251,69 LO PS:t1lwCSiNG ClT 10.1 -MM -419-040 $230,00 rn TONG MOTION FEE - liESID 1.00-000-241-000 ORADING ME 101-404-42-1-000 $26.00 �( C` INF 'RASTRUCTI1RE.FEE 225-000-443-342 $6,000.00 `' � ART 1N N113WC PLACES - RESID 701.-000-255-40Q �698.CY1 c SUBS VEAL CONS'TRLICTION AND PLAN CITECK $10,306.80 LESS .PRE -PAID FEES $0.00 TOTAL PERMITFEES DUE NOW 510,306.80 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION l: G OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs r, OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts . Forms & Footings Ducts _Slab Grade Return Air Steel Combustion Air Roof Deck IV, 4 Exhaust Fans O.K. to Wrap fo, f F.A.U. Framing; , , Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wail Firewall Equipment Enclosure Exterior Lath OX for Finish Plaster Drywall - Int. Lath i . Pool Cover Final Final POOLS - SPAS BLOCKWALL AP ROV LS 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 OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 1,4 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) F 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 .t_ U) : 4 F-' U) CVJ W. O 7-) C 0 LOW W � Ot` ,T^ W IZ W W H CL Cn Z Ch L0 CV O� UQ o Z Lr)�O u_ X W — mUU O �M� v Z_ co :D �O Q J LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury 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. License # Lic. Class Exp. Date 732241 B ate " Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury 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. 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. ='Ali1.r :!'Ad*;11tri1�It`s ( MC-511K►94,1. (This section need not be completed if the permit valuation is for $100.00 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 shall forthwith comply with those provisions. /Date: Applicant Warning: Failure to secure Workers' Compe sation 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, 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 tl dabove-mentioned property for inspection purposes. ignature (Owner/Agent) f Date BUILDING PERMIT PERMIT# CONTROL# 97404-IN,S 4 912 DATE 4/2/97 VALUATION &.00 LOT R TRACT }81 1 P JOB SITE ADDRESS S0434 1110AN i'� A GE, APN 761-470-038 OWNER CONTRACTOR/DESIGNER/ENGINEER TOM 'RIC HARDS) MENA0E DESUGN INC �t14� 1�ER1:f I'A 83711 ��rci� sr LA QUINTA CA 92L53 ININO CA 92.201 (760)775-15W_>W C13C0 8367 USE OF PERMIT SUF?i>1,0W N*fd/ 1. 16) (J lt&RT 05.1116 8110'WING 0iA2+GE OF CiW-M-ltS"BP 1,.0AAVT Vf� -E, SUltON;IAk !fi ` yF 1 ' . - ppR p 219 1 :+1 T63.'1Y.1 i'Ai. CON 11d.4-{` ON AND 11KA)% Of �1). I'€) AI, f'Ialtl 11T 8+'KVN OVIH. NOW-`so.0lR '•` RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air. Roof Deck Exhaust Fans OX 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 Final Final POOL_ S - SPAS BLOCKWALL APPROVALS 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) RECREATION -CORPORATION April 1, 1997 City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 Re: Richards Residence Lot 8, Tract 28118 Gentlemen: This letter is to inform. you that on January 3, 1997, KSL sold the home at the above referenced address to Mr. & Mrs. Richards. Please be advised that the Richards as owner in fee are now responsible for any and all changes to this residence after that date. Thank you for your consideration in this matter. Sincerely, Pk bl Paul W. Dooley PWD/pv America's Leader In Distinctive Lifestyle and Recreation 56-140 PGA Boulevard • La Quinta, California 92253 • (619) 564-1088 • Fax (619) 564-4880 �rZaUcf-lo car►istmarlo amu corgi . 2S 1Narch, 1997 City of La Quanta Bul1CLng Depurtment 7R-105 Calle Estado La Quinta. CA. 92253 Ceatletnen� Rancho Capisttano Development (Li xnse p 59195) si40w that our comPmy and �aThc borne nse be removed from the building of Lot S Tract 2a 1 la, Stma aedre� so 234 Hcnnluge La Quin vnr- conveyed to th,e new owners Mf. & 1 in. Ridwrds on i January. 1997. The Rlch.'afds haveundertaken remc Jeling on the home using their own Contractors. consequently we would like to be cecnoved as the Cor tractor of record due to the p0Icnti3l liability. tnccrely mbcA- presidcnt &Incho Capistrano Dcv. Corp. P.Q. Box 960 . La Quinta, CA 92253 • (619) 345-7753 • fAX (619) 343-6684 Contractor tie. B397aT5 TOTAL P.02 03/28/97 05:33 TX/RX N0.0378 P.002 M