9809-056 (SFD)LICENSED CONTRACTOR DECLARATION .
Uhereby affirm under penalty ofperjury that am licensed under .
Chapter o(commencing with Section 7000) ofDivision nof the Business and
Professionals CoUe.and myuoonaoisin�n�xeffect. �
License � uv.olasm sxp.Date
747866
47
OWNER-IBUILDERDECLARATION
' hereby affirm under penalty of perjury `^~'~^~^.',,'_' the Contractor's
License Law for the following reason: ` .
( ) |, as owner of the property, or my employees with wages as their sole
compensation, will dothe work, and the structure isnot intended moffered for
sale (Gao.ro44.ousi?aos&. Professionals Code).
( ) |, as owner of the property, am exclusively, contracting with nuanood
contractors to construct the project (Sec. 7044. Business u ProfessionalsCod*). . ' ` '
(> |umexempt under Section suPC.for this reason
=____�__
omo Signatureo/Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm undo, penalty of perjury one m,'vfono*ing noo|ummons:
<)| have and will maintain acertificate ofconsent self -i nbkr workers'
ccimpehsation, as provided for by Section 3700 of the Labor Code, for the
performance o,the work for which this permit ioissued. '
( > | have and will maintain workers' compensation insurance, oo,noquiredby
Section 3700 of -the Labor Code, fo,ma.porfomnanoo of the work for Which this
permit is issued. My workers' compensation invumnuaoamo,&policy no. are:
Carrier 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,
1. shall not employ any person in any, manner so as to become subject to the
workers', compensation laws of California;.�ncl agree that if I should become
'Subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall *forthwith comply with those provisions: V%2,0
Date: Applicant
Warning: Failure to secure Workers' ompensation 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 mhereby mthe Director v,Building ` anmSafety
for a bennu subject to the, conditions and restrictions at forth on his
application:
1. Each person upon whose behalf this application is made &each person gitl
whose request and for -whose benefit work i rfod under
any permit issued aoaresult o/this appnoatonagrees to, &ohoU.indemnify
& ho|U xa,m|oao the City6, La Ouinto, its o#ioors, agents and omp|oyoes''
u. Any permit inauedaoaresult oxthis application becomes null and void if'
work is not commenced within 180 uuyo from'date of issuance of�uCh
.ponni�.o,00000cessation of xfor 1Vodays will subject permit tocancellation.
ioortify that | have read this application and state that the above information io�
oonom. | agree vocomply with all City, and State laws relating mthe building
oon�mcVon. ang hnmbyo��ohzo mpmaon�Uv000/�mioCuymemo,upgn/;
the above-mentioned propertyf inspection
Signature (zwnoir/Agont)
BUILDING PERMIT
DATE VALUATION LOT 9809-06 TRACT
*. 1. 4 1 77-130 VISTAFLOPA
631-380-032
OWNER
CONTRACTOR DESIGNER ENGINEER
56440 PGGA BLVD
5�920 PGA BLVD
LA QUINTA CA, 9225.3
LAQUMTA. CA 92253
(760)56,1-7166 C8L# 5323
USE OF PERMIT
LOT 14, PH 2 PLAN 2A - SFD �PERMIT DORS NOT INCLUDE Bum -'K
WA.LL OR POOL. PLAN 0%'CK FER REDUCED 73%* FOR MULTIPLE
PERMIT FEE SUMN"Ry
PLAN(1%C%FEE 101-000-439-318 3160,21
ELECTRICAt FEE 101-000-420-00 $131.09
PLUMBtNG FEW, 101-000-419-000 4.59
CRAUINO FEE 101-000-423-00.0 $20.00
INFRASTRUCTURE FES '225wOW443-342
CONSOUMMON AND PLAN CRECK
$4,30-.08
NOV. tOTAL PERMT.T FEES, DUE NOW
S4,367.88
RECEIPT-
DATE
DATE FINALEb
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 Wrap
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
Final
Final
BLOCKWALL APPROVALS
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
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:
LICENSED CONTRACTOR DECLARATION
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 # Lic. Class Exp. Date
747866
f
Date Signature of Contractor
4/30/00 ..
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors
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
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:
Carrier Policy No.
ZURICH INSURANCE WC683896506
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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. . t .
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 Ouinta, 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.,l 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 property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE NOV VALUATION LOT 14 9809-056
5132,492.70 TRACT
28545-2
JOB SITE
APN
ADDRESS 77-130 VISTA FLORA
1 631-380-032
OWNER
CONTRACTOR /DESIGNER / ENGINEER
KSL DESERT RESORTS, INC.
KSL LAND II CORPORATION
56-140 PGA BLVD
55-920 PGA BLVD
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)564-7166 CBL# 5323
USE OF PERMIT
SINGLE FAMILY DWELLING
LOT 14, PH 2, PLAN 2A -' SFD - PERMIT DOES NOT INCLUDE BLOCK
WALL OR POOL. PLAN CHECK FEE REDUCED 75'/o FOR MULTIPLE
ISSUANCE OF SAME PLAN TYPE.
CUSTOM CONSTRUCTION 1,674.00 SF
PORCH/PATIO 157.00 SF '
ESTIMATED COST OF CONSTRUCTION
132,492.70
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 S755.00.
PLAN CHECK FEE 101-000-439-318 $160.21
MECHANICAL FEE 101-000-421-000 598.50
ELECTRICAL FEE 1014000-420-000 $131.09
PLUMBING FEE 101-00(}-419-000 $174.50
STRONG MOTION FEE - RESID 1014000-241-000 $13.25
GRADING FEE 101-000-423-000 $20.00
INFRASTRUCTURE FEE 225-000-443-342 52,934.10
ART IN PUBLIC PLACES - RESIE 701-000-255-000 581.23
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,367.88
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
S4,367.8S
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR