9711-025 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
�F�— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
C.,) License # Lic. Class Exp. Date
LO
W + �i.2 T3 •� �.) pag
Z Date Signature of Contractor ow
CD O O r
U C) OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of perjury one of the following. declarations:
p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U (�.)' I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
dLOpermit is issued. My workers' compensation insurance carrier & policy no. are:
�t Z Carrier Policy No. r
ob Z) R UR'll" T /1V 1, CO. Y tt C ii�31!•'�I1/.70
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(This section need not be completed if the permit valuation is for $100.00 or less).
( ) Ipcertify 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
3 subject to the workers' compensation p'rovisions'of Secti n'3700 of the Labor
bode, I sh II forthwith comply with those,provision's.
t;�Date: � V"� Applicant "P4Z !- f x 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
i 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 ;
the°above-mentioned prdpert%y-for inspection purposes.
Signature (Owner/Agent)- rt"��%
BUILDINGPERMIT PERMIT# CONTROL#
y71 t-li S
DATE tl f Y I VALUATION 533213 5.60 LOT TRACT � �. d %4
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JOB SITE
APN
ADDRESS i{�� ,
761-4-024
OWNER
CONTRACTOR / DESIGNER / ENGINEER
KS1, t.AHTD 11
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'6.1,10 PGA BLVD.
56140 PGA RIND
LA QJTVI'A CA 9275 3
I.A Q$011-xrN CA 9;; SZ
t.760'17711 -W2 VAl.lf �114$76
USE OF PERMIT
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5+�,9t1l.3it
NOV
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RECEIPT
DATE •
BY (
DATE FINALED
INSPECTOR
It. Ir. i-
F{I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
A 4Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
7—
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
_ Z _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
"Party Wall Firewall
Exterior Lath
4
Drywall - Int. Lath
Final
Final
BLOCKWACC OkOVALS
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
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 A PROVALS
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)
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045.
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
OTHER
wYi
JOLQCATICI _
REPORT SEQUENCE NO.
TYPE OF TRU TURE
PERMIT NO.
D TE_.
OAY OF WEEK
MgRIAL DESCRIPTION
ARCHITECT
LUSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
RS. CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTOR CONTRACTOR
1
n
1 e.
J
o .
COPY SENT TO CLIENT
ONTINUED ON NEXT PAG
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
"KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
(rONC� &AA�
SIGNATURE OF REGISTERE I PECTOR
r�
0_7
SC a
DATE O REP6RTf REGISTER NUMBER
A. -
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
ollowing.
BUILDING ADDRESS: 80-300 HERMITAGE
Use Classification: SFD Bldg. Permit No.: 9711-025
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND III
Building Official
Address: 56-140 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 7-30-98
POST IN A CONSPICUOUS PLACE