9809-055 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that 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.
rbr
747966 b
bate =.y"am"vv'Contractor—
OWNER-BUILDER
on'rauv, ~,~~~.~^. DECLARATION_~�
I hereby affirm under penalty of perjury that |amexempt from the Contractor's
License Law for the following
( ) |, as owner mthe 'pmporty, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended moffered for
sale (Sec. 7044. Business mProfessionals oouo). N.
( ) |, as owner of the property, mn exclusively contracting with licensed
contractors to construct the project (Soo. 7044. Business .& Professionals
Code). .
()|amexempt under Section ���_�omPcm,this reason '
Dom ' Signature of Owner
WORKER'S- COMPENSATION DECLARATION
I hereby affirm urider penalty of perjury 6ne 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.haveandwill maintain Worker-.' 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.
(This section need not be completed if the permit valuation is foEr $166.00 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
%�orl<ers' compensation laws'of California, and, agree that if.1 should become
subject to the workers'.comp ensation provisions of Section,3700 of the Laboi
v""e'Pwith comply with -those provisions)
/ Compensation4overage is unlawful and,
shall subject m criminal penalties and -.civil fines up to $100,000, in,
addition to the cost of compensat ion, cl�mages as provided for in Section 3706
of the Labor Code,* interest and,attorney's fees. . .
IMPORTANT Application is hereby made to the Director of Buildingand Safety
for a –:permit sub-ect to the conditions`
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 te
any p^^^'~~~~,~~~'~`~'~ `~~,,~~~'' ~o'``` ~'~~^~'`^'~~^^^/, *
& hold harmless the City of La Quinta, its omoera, agents and employee s. �
o.Any permit issued asamouuo«this application becomes null and void x
work is not commenced wnxm 180 duvu from date o/ issuance of such
po,mit, or cessation ofwork for 180 days will oubjoutpo,mumcancellation.
| certify that | have read this application on d state that the above |nfn"n°non is
correct. | agree mcomply with an City, and State |mwo relating tothe building
construction, and hereby authorize representatives of this City t enter bpon
the ab ntied for /
Signatu�e . oate
PERMIT #
PERMIT
DATE. VALUATION LOT' TRACT
$132092.70 13 18545-2
JOB SITE'
APN
ADDRESS
146 V4 IA FLORA'
032
631-3804
OWNER
CONTRACTOR DESIGNER ENGINEER
KSIL DESERT RE SORTS, Wilt.
KSL LAND U COF' TOPLA110N
QUNTA CA 92253
LA QUfNIA CA 92253
.LA
USE OF PERMIT
UW 113, PH 2, PLAN 2,18 -'SFD - PERMIT -DOES NOT INCLUDE'ALOCK.
NVALLOWPOOL. PLAN CHECK FEE RMUCED 750/a FOR IvIULT.IPLE
CWTOM eONSTRUMON 1,674.00 SF
IS7.00 SF
ESTINIX17 CD COST Or, CONSTR UM ION
132.492.70
PERMIT FEE SUNIAL-ILRY
CONSTRUCTIONFEE 10.1-000-4.18-000 $755.00
MAN CHECK Rh� $160.21
INIECRANICAL * FEE W000-411-000 $93,50
ElECTRICAL FEE 101 -000 -420 -ON
PLUM)3ING Frig '101,000419-000 . S,174.50
GRADING FEE 101 -000-423-000
'225-00-443-342. S2,934AD
0 55-000
AWr IN PUBTAC PLACES RESTC701 -00 $81,23
.1MAL CONSTRUCIA10NAND PLAN CHECK
$4,367,88
Tj-
ECEIPf 14,
DATE
DATE FINALED
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 Plbg, Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines a
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: