9708-069 (SFD)CV LV
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" LICENSED CONTRACTOR DECLARATION
-1 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 # yyLic. Cla's's" �. Exp. Date
,3,12&3 f3'
rt 11 �
/Date` e/9 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
S,e tion 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.
ZUTUC13i INS. 001. 6f;3394505
(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
sybject to the workers' compen""sat o pIovisions of Section 3700 oftthe Labor
Code, I sh II fo with comply with those provisions.
ate:``�Applicant
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 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. Lagree 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 purposes.
JSignature (Owner/Agent) t ')t . Date e_
` BPERMIT# CONTROL#
BUILDING PERMIT
�7t17�.f?h1J 7
DATE VALUATION LOT TRACT ;5,,�3•j•Pt�
���t"6/15/,77 83�,Z�� I1
JOB SITE
ADDRESS`JiYI&
1.f.,I
OWNIS�ER
CONTRACTOR / DESIGNER / ENGINEER
y�
36-i40PGA BLVD.
iOilPGA c►i,V_U
LA QwN'TA (-'A 922:3
1A QU1`N1'A C;k1 92.253
(7611)771-?WQ CBL* 467/.1
USE OF PERMIT
SPD
PAR LL 7..1, LLA 97»465, i'fi 2,3118
1�Eet.1`1'AOL� f�LAN yea. ifi1.FR1:f �::I��c:�. �i�•;Fr',1t3�.L'�1�GF:1> '+'S�n:�"U� 3�tu�.����1.�
,ISSUE,, OF 8A4ft;.P1,AN TYPF.
CU -3` 7 /;M COINS' RUt.. A�lCIiJ «>Is7: ,W ;tit^
PC,ic.ClUPX11C 364.W SF
CAKAOWCAIt!'t<;RY 677.00 SF
.V:. 111NIA Ir�P D CONT �3�1� CONIS �t�.3�.°' TOIN
244.,'x 109,1210
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II�if"Ri'F", iT Ffl,E �l�ANildY,�L' R Yr
i;;%iNS'l.KI.�C."f'1<,;+t<i l�b:t.? lOP.-00(?-d�ti-L?[NJ :�1,:[:,L�^i 4%►
P!IAN Cr tL*0<' 'FFI;
jN:3:C!HAT4;1CAL PEP ".01 _0010-412 1_000
j�f L "! tCit At. iso 101,-000-420•-000
P•;.A9k1b1_NG .f: fX 10 1. -UC& -419.000 $1,79.25
:41`Rf?tJC#'Njf?i°1t1t�f'HT} .'Q?1:M it) 1-0)(t-241401 124.18
f•T, I WT 7'101_0W,1221000 i�
.+iril.e>1cv �% $210 (to
A10.' 1N er1 IBLit.; f11.AQ-.3-.KfzS(t) 701,-t0)� ?.S5-IXit}
AND PLANG'a•tr'ICK
34.47
1997: LE .. PRE -TAM FEE
UIA
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NAt, AUC NOW
S7,534.47
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Steel
Ducts
Return Air
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
`i/ 7
F.A.U.
Framing
Compressor
Insulation
/Z /7 $7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation.
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
3
Final
Final
BLOCKWAL APPROVALS
POOLS = SPAS
steer
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
Final
Utility Notice (Gas) —4rlWed led-,
ELECTRICAL AAPROVALS
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:
°
--:�-�, JON TAN DY
3580 Condalia Ave.
SPECIAL INSPECTIOVSERVICE� Yucca Valley, CA 92284
(760) 365-5045.
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF ❑ REINFORCED CONCRETE �(STRUCT. STEEL ASSEMBLY ❑
INSPECTION 0 POST TENSIONED
ASPHALT OTHER
PERFORMED O REINFORCED MASONRY
❑ FIREPROOFING
J08 L A -I -4 � �� \aU\` REPORT SEQUENCE N0.
TYPE OF RU URE y 'F\- PERMIT NU. �}` TE aLA 1 DAY OF WEEK
• a
M ERIAL DESCRIPTION ARCHITECT P TOR HRS. CHARGED
O
+ 1 ENGINEER ASSISTANTS HRS. CHARGED
INSPECTION GENERAL/�� 1 SUB 0 �O\ n� `
DATE CONTRACTOR /'1 CONTRACTOR � ` 1 �
1/Q C C)\.
A
COPY SENT TO CLIENT
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. 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
mam.11e _w
CONTINUED ON NEXT PAGE O PAGE OF
_� TUO�EGISTERED IN ECT',OR
V
DATE OF REPORT REGISTER NUMBER
Certificate of Occupancy
City of La Qdinta
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 ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
Owner of Building: KSL LAND II
80-444 HERMITAGE
Type of Construction: VN
Building Official
Bldg. Permit No.: 9708-069
Land Use Zone: RL
Address: 56-140 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 5-15-98
POST IN A CONSPICUOUS PLACE