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9807-263 (SFD)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, and, my License is in full force and effect. License # Lic. Class Exp. Date 74786.6 � /� �% 4/30 ,00 VIDate �7 Signature of Contractor k , - �! `�j, 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). ( ).' 1, as owner of the property, am exclusively contracting with licensed contractors to ,construct the; project (Sec. 7044, Business & Professionals Code). a O 'I am exempt under Section B&RC.. 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. 06 (This'section need no 4 be comURAp eted if the permit. valuation is for 1 om or less). ( ) I certify that in the performance of the mork 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 s,,-halj forthwith comply with4hose provisions. pate: / Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000Jri 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. I agree to comply with all City, and State laws relating. to the building construction, and hereby authorize representatives of this City to enter upon .r. the above --mentioned property for inspection purposes. Z WIfnature (Owner/Agent) A yyd J//J�� ' -< Date 4fl" '^�✓� " BUILDING PERMIT PERMIT# DATE VALUATION' LOT 9807-2673. TRACT 8/1.91913 $195,449.20 21 28545-2 JOB SITE ADDRESS APN • 77.29$ VISTAFLORA 631-3'8'0-072 OWNER CONTRACTOR / DESIGNER / ENGINEER KSL DESERT &ESORTS, :fINC. KSL LAND 11 CORPORATION 56-140 I't3A BLVD 55-920 PGA, BLVD LA, QUINTA CA 92253 LA. QLT1NTA CA 92253 (766).%4-'7166 CBL/1 5323 USE OF PERMIT - PLAN.3. - 8F - Ni:. Wf'1' 1�O.M N0T INCLUDE _n;i.O K WAU OR PMOL„ 75°d MAN CHECK REDUCTION APPLIEV. ,LA Q.U;fNTA.RFMORT IH.OMES. t[!S`j'ONIC©NS'I."Ri7C'C1ON 2,:3aa.r><3 �� . PORCMPATiO 691.00 SF C,9TI NIAT1✓1) COST OF CONS TRi,°M.I N ;1195,449.2.0 CONS TRUC`T1oNr FEE 101-0004161.000 $975151+ PLAN CIAECK FEE IC�1 11i�31-439=3113 520T.98 MECHANICAL f8F, RLEC PdCAI, FE_ 101-000420-000 $14-1. 19 PUAl fNCr.I~W 101-000.419-000 $1988 S'!'R0140 MOTION FEE "- ft MID .101.-000-141-000 $19. 544 GICAD1i�ICff 1,0:1-1)011- tz3-ik3a $;''i,t�0 !Nf".f2.��3 t`t�LfC�l Uld)r:,1+.hr 225 001) 9 3-342 $4,190,83 } Wf IN PUBLIC 1'1LACS S�R, P8 It 701-000-;255.000 �t SUB,-' 0TAL C01`l�a i`f1 C.t("1'ION AND 1'f:U1N CI1EC:h; $6,105,16 LFSS P E-NVID FEES $0,00 TOTAL PERMIT FEES DUE NOW -�1 �f,105.1d► r RECEIPT DATE' BY .;� 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 OX 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: