9512-118 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
O LO License is in full force and effect. 597975 8 111196
r W License # Uc. Class Exp. Date
Z^ Date Signature of Contractor i 1-tP
0 r`
OWNER -BUILDER DECLARATION
J I hereby affirm that I am exempt from the Contractor's License Law for the
HIL
W following reason:
Z ( ) 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 Cone).
( ) 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
C0 Date Signature of Owner
ulN
rn WORKER'S COMPENSATION DECLARATION
CL
Q 1 hereby affirm under penalty of perjury one of the following declarations:
C) Z () I have and will maintain a certificate of consent to self -insure for workers'
r �O cc compensation, as provided for by Section 3700 of the Labor Code, for the
X W W performance of the work for which this permit is issued.
mJ U (1�� I have and will maintain workers' compensation insurance, as required by
Q Section 3700 of the Labor Code, for the performance of the work for which this
p U permit is issued. My workers' compensation insurance carrier & policy no. are:
d LO Carrier Policy No.
. ? (This sectiop qqt i%i , completed if the permit valuatio `s� p6 $1 .00 or less).
r C3 () I certify that in the performance of the work for which this permit is issued,
g 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
0 �+ Code, I shall forthwith comply with those provisions.
Date: Applicant r
- 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 3708
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 persori 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
- 5"oto 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.
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 6i eby authorize representatives of this City to enter upon the
• °�
above-mentioned property for inspection purposes.
Signature (Owner/Agent) iwi"I G" '_ Data F;
t-+.�:�rq:s.e�,eti�.rs_s��..+.o;,�+�e-,..—++�t.".:a„f!.^..s, .a....-�.�:se-•�..�.�.t•...o�� ;�,e:�r --'tee «�;
A"'
PERM -IT
PERMITS
9�ix-�
ry�y
DATE f Z/4(e/�.�
���CBUILDING
VALUATION i.o.�'S.�l6 r>j
LOT 10 +
TRACT
JOB SITE ADDRESS
80-266 MRAWAGIZ
APN
761-470-040
OWNER
CONTRACTOR s
RANCHO CAP.ISTRANO DEVELOP
KSL LAND 11
79637 COUN111:Y CLUB DR 920
56-110 PG- A BLVD.
BERMUDA DUNES CA 92201
LAQUINTA CA 922.53
(619)345-7755 CBLl 1969
DESIGNER/ENGINEER M
'1313 O APC11ITECTS
26 CORPORATE PARR.
USE OF PERN-GINGLE Fd1 ML Y WELLING
,
ratrtar- s• -r a
PGA WILST - TI -W (V MT:IMS COLLECF11UN -- _ _ -
PLAN Z•8R
FEE DESCRIPTION
FEES
CUS'.1'OIb1 CONSTRUCTION 4,250.00 LF
PORCH/PATIO 790.00317
0AA.s1QE/C[\P.Y0Wf 713.00 SF.
VS11MATE, D COST OF CONSTRUCTION
35545 56.80
ll'ERM11" F&E SUMMARY
PL.A:N CBECK FW, 3 101-000-439-318 $1,249,64
CONSTRUCTION FEE 101-•000-418-000 $1,535.50
WICF[ANICAL FIS 101-000421.000 $14150
ELECTRICAL FEE 101-000-420-000 $239.51.
P.I,CPk1 RNCf t~ 10 t -000-4:i 9-000 $2"A<0q
STONG ta10'1'10'N F'I 1 - RESID 100-000-241000 $35.56
00
GRAD_ NG FEE 101-000423-0 $20.00
( CIQ
1N RASIRUC"TURE Fa 225-000-443-342 $6,000.00
al C-)
M- TI ISE PLAN 101-0,00-441-345
ART[N PUBLIC PLi 03 - RESIr 701-000-255-000
SUB -TOTAL CONSTRUMON AND PLAN CHECK
$10,111.60
LESS PRE -PAID FEES
$0.00
1
TOTAL Pf.RA'IFF FEES DUENOSY
$14;111.60
,
'
RECEIPT
DATE
BY
DATE RNALED
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 -
O.K. to WrapF.A.U.
t4v
9
Framing
Compressor
Insulation
_1�
Vents
Fireplace P.L.
—Ell
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
KL5/f 7 1
POOLS - SPAS
/
BLOCKWALL APPROVAL 9
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Eleftic
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
Fbdures
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 OFTM °`4Q
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of.Construction
Owner of Building: KSL LAND II
l
Building Official
80-266 HERMITAGE
Bldg. Permit No.: 9512-118
VN Land Use Zone: R-3
Address: 56-140 PGA BLVD
City: LA QUINTA, CA., 92253
By: DANIEL. P. CRAWFORD JR.
Date: 2/25/97
POST IN A CONSPICUOUS PLACE