9708-071 (SFD)w LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
11-- 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.
O ch License # Lie -Class Exp. Date
U-) i7 M I �
LLJ i2_3 3/311 9
i1
6 Z r— Date Signature of Contractor. bo.f
O(]" f
J U C:) OWNER -BUILDER DECLARATION
Wd I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
cY) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
O
U < 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
pe�rf� rmance of the work for which this permit is issued.
l ) 11 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:
Cartier ry Policy No.
(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_Cali 'fornia, and agre that if I should become
subject to the workers' compensation provisions of Se � tion 3700 of the Labor
JCode,I srh I orf�i�n IEh comply with se p "vi io ' .
Date: / t �/ 7 Applicant f _
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. c
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 top '
any permit issued as a result of this applicator 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 herebyua thorize representatives of this City to enter upon
7(above-mentioned property for inspection urposes. ,
Signature (Owner/Agent)lett. Date f� 7
PERMIT # CONTROL #
BUILDING PERMIT►K-ai,�x 5741
DATE VALUATION VALUATION+�ij�Z(�ttjfl LOT j'1 TRACT ►��`A'}r:�,j�;
ADDRESS 80-476 HEIJ MA 3 ACE JOB SITE
APN 761—_%0-W5
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ICS11,1 1AND II
Ill '" F VIIFJI :!PI VIs r CGIRP
56-1410 PGA 13LVDL
56140 PGA 81. VO
L.A. QUIMI-A CA 9115:4
3 A QUINl'A CA 97.,253
CBUI 46%,
USE OF PERMIT
4.D
1-413JI11 'AI-j'is KAN :311. PLAN CklWK F643,1UWLtCt: U 75WVOR ivliA:I'IJ11,19
13,801 kOF SANIF .,I&AN'CYRE.
CUSTOM tr:ON:iI."RUC TION "3,44.1.,04 S
f"�h�'.t4ia.FS`.If Sly+.�►fi iii
GARAQWCARVIOR.'r 7271.00 Sk+
a:MIXT:ED COST o eMST �UCC1t�� �
--�`
`89"lo .so
7 meg /�`. .�1 {,�,yg� p gy
i8.4ti�i.LY"��f $�-f 51,* 17�,J.lYflYAAWI
C -C' i:3'[ li;.f:It-MILIN M Stil4, hl3-418-(x40
I IE'C tMAC?AL FEE 1'O#AIO-421-M
�t±i "l'►i�w. h�i, .13 $19148
:i„lr!1 iT#C1 rm, I(►-tJ(i!)-4.I„-fJt)i} 5�1:�'ZS
STRONG vCsION "3M - J014h."11-01(N
CRADIT14C Pr 601-000-a3000
W-000-443.3411 1'+i.l .tiil
M' l'!`t'.€ OBL C PLACES :, >RE81r.
ESS PRE -PAID FILMS
$0.00
`:
� A 151991
UK
CAiN
�TCEIP.T,;�•
DATE
BY ,.
DATE FINALED
INSPECTOR
i 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
7
Exhaust Fans
O.K to Wrap
S —7
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
_ 6
AMA -
Final
Final - —
BLOCKWALL APPROVALS:
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 Piaster
Sewer Lateral
Pool Cover
Sewer Connection
3
Encapsulation
Gas Piping
Gas Test
_ $ —
Appliances
Final
Final
Utility Notice(Gas) p
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) yy
COMMENTS:
SPECIAL INSPECTION' SERVICE I
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045.
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
OTHER �n(� `'
MSL\
J0p L CATION
\ 1
wt`' -
REPORT SEOUENCE NO.
TYPE OF STR TUR
,
PERMIT N0.
DATE
DAY OF WEEK
M TERIAL DESCRIPTION
ARCHITECTTSELCTOR
HRS. CHARGED
E
ENGINEER
ASSISTANTS I
HRS. CHARGED
INSPECTION
DATE
GENERAL` I
CONTRACTOR v
SUB
CONTRACTOR
r°
�.CCS.
, l
'/( CCA
a
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE ❑
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.
I+NA_ RE OF REGISTERED I
ECTOR
\
DATE OF REPORT REGISTER NUMBER
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 ADDRESS:
80-476 HERMITAGE
Use Classification: SFD
Occupancy Group: R 3 Type of Construction:
Owner of Building: KSL LAND II
Building Official
VN
Bldg. Permit No.: 9708-071
Land Use Zone: RL
Address: 56-140 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 6-4-98
POST IN A CONSPICUOUS PLACE