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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, c my License is in full force and effect.
License # Lic. Class Exp. Date
%342' 1; 1i31%',��
Dater?//_5:_/?7 Signature of Contract���
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
Se/Etion 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. INC
(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
spbject to the workers' compensationprovisions of SectioTr3700 of the Labor
ode, I sh II forthwith comply with hose prow sion
Date: ,Applicant .1 f" I�,
Warning: Failure to secure Workers' Compensation coverage is unlawful a d
shall subject an employer to criminal penalties and civil fines up to $100,00 , 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 x•
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 hepby..authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
ignature (Owner/Agent) ate _
PERMIT # CONTROL #
BUILDING PERMIT ���().7
.5750
� VALUATION $241. �,zQ LOT �4 TRACT L(,ea ;?-„ita+
DATE /j ��A
JOB SITL
ADDRESS "12 M110-1 TACE
APN
761-M41419
OWNER
CONTRACTOR /DESIGNER/ ENGINEER
KSi, IIIAND 1`j
KSL i1i3VIfLlJPMENrI' CO`RIP
56-•14{) .E'GA BLVD.
56.1431'Ciai UVID
LA Q1„f[VI A CA 9225`21
LA QUINTAL CA 94'2% i
g60)771.3fi s CRIN 676
USE OF PERMIT
8614_1'TAQU, .P4A N 28.:PLAN 0 1EC K FrE 1"tI61M 75' ; FOR NKIL`t'WIX
lSKAE OF SAW PLA N'Pi'P:E,
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2.4.1>339.a11
C QNS'110ICTION 0X0 i01_(XX)__j l841t3Q
i?),!!'Afr;41!`;�:,'►; k{'f�; 1!)1-i}(lf9.di`�-'ti1's $5i}i,•g7
)�.dt�'ECi:j�:"r>wl.. h's.;f"s jE11=(1t.►l)�')21-�1GI!) �l7s.yC,
pl-UNI.f iNfIly1%.f l: 10140) 419.000 SJ79.25
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(31Rrt+;:.FWIC.i it 1()1"(0101'1na_}�0i0
tile? ArilltirC"f'iT tE ii is X25-t3v+ -4413- 42 a6, J2.1146
ART 1N Pl lK.1k;1'':l.A_C `i - Elf 411; 101-04)()-755.000 � i�d,fsft
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t l' �T, i'f')l�i i } 1,)��1'li'"?11! AND 1�(.1 N CF11::X:
`l.'7,514.47
1997 "a*eaTAL P; ;RN;l T aPERS OVE NO
S7,�47
AUG 15
LA
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DATE
BY
I
DATE FINALED
INSPECTOR
AN' - I
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5
I
E
x It
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 Wrap
F.A.U.
Framing
7
Compressor
Insulation
j,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation .
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
/
O
Final
Final o 7
BLOCKWALL AP ROYALS
POOLS - SPAS
SteeL>
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
— 5 - Q
Encapsulation
Gas Piping
Gas Test
-
Appliances
Final
Final
Utility Notice (Gas) o
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:
f
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045.
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE )(STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
x OTHER
Q
1 �('-xdM
\ 1
JQ@L CATIONS 1
REPORT SEQUENCE NO.
TYPE OF�RUCT-URE
PERM NO.
TE
�
DAY OF WEEK
M RIALYYYYYY'''"'DESCRIPTION
ARCHITECT
STOR
HRS. CHARGED
1
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
SUB
CONTRACTOR P
aLk
x VC4
On
COPY SENT TO CLIENT
CONTIN ON NEXT PAGE O
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.
_ �S GNATURE OF REGIS D INS TOR
�-4�.s
DATE OF REPORT REGISTER NUMBER
Certificate of Occupancy
City of La Quinta
Buildingand. 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 ADDRESS:
Use Classification: SFD
Occupancy Group: R 1
80-412 HERMITAGE
Type of Construction: VN
Bldg. Permit No.: 9708-067
Land Use Zone: RL -
Owner of Building. KSL LAND II Address: 56-140 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 4-30-98
Building Official
POST IN A CONSPICUOUS PLACE