9807-261 (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
/r 747866 $ ,, 4a30i0i}
✓ ate 2 r! Signature of ContractorrY +ti•'
Gt' • y �'
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). • •
( ) 41 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.
zu1 zC .i'�Ts111 ;� ' C11 1iVC6R 330
(This section nee no be competed if the permit valuation is for $100. 0 or less).
O 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. j ��
Swloyer
A licantpl?secure oV11 rkers' Compensation coverage is unlawful and
to(crriminAl 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. 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 .
the above-mentioned property for inspection purposes.
Signature . (Owner/Agent) 0 / �':�f24 Date,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9807-261 TRACT
I 8/1.9/98 $130,872.00 19 28545-2
JOB SITE
APN
ADDRESS
77••3313 VISTA FLORA
631-380-072
OWNER CONTRACTOR/DESIGNER/ENGINEER
. i
KSL DESERT RESORTS, TNC!. KS1L LAND 11 CORPORATION
56-140 PGA. BLVD 55-920 PGA 81,11)
.LA QT *rr.A CA 92253 LA QUINTA C,.k 92,253
VM564-7166 CBU 5323
USE OF PERMIT
fAM
PLAN 413 - SF#A, P 11'1 DOES NOT MC LURE ErLOCK WALL, Oft POOL.
7.01'e PL.,kN CW,..CK R13DUC`i'.1,:,N APPI.'ffD. LA. QU.TN' '.A RF$0R`P HOMES,
PH A. R
CUSTOM CON91RUC'nON 100.00 SF
• :s
E.S RAIATL4 Q COST O CZ2NMUM[ON
72.00
13% 872.00
PERMIT IT FEE SLNMIARY
CONSTRUC`WN F.F.1:: 101400.4113-000 $748.00
,
PLA 14 CHECK M 14;.i.-004-433-3! S $10-13
MECHANICAL f:� [( . C10c)-a23-Oo0 S1.37.00
fLM-717 RfCA:L F. E•. 101.000420-000 $1.16.30
PI. E GING I"L•� 101-000-4,19000 $169:75
$ RONCr 1lKYRON f'EP - RE -s11? .101-0,00441-000 $13.09
GRADMIG F.68, lti:i-{100-423 00fl $20.00
!', RIA S T1tf3t.'•' URE FEE 2.25-007-443-342 $2.944.62
Ait.T IN PUBL:f.0 PLACES RE8fl,- 701-000-255-000
\ , §LfB MT_AL CONMUMON AND :PLAN CHECK
$4,386.09
LESS 'LIRE-PA10 FEES
10.01)
TOTAL PFRl%f[T F:E ,.S'i)UENOW
S4,386.09
RECEIPT
DATE''
F,'
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
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
'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: