9807-255 (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
. 74 i866 33 4 00
Date �!% Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exemptjrom the Contractor's
License Law for the following reason: r
( ) 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).
O 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:
O 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.
(This section, ee o e competed if the permit valuation is or 100.0 qr 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
�Oa/
ee/, I shall forthwith comply with those provisons.te: /^ Applicant -�
Warning:, Failure to secure^rkers' Compensationseoverage is unlawful and
shall subject an employer to;crirninal 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 herebymade 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.
Ignature (Owner/Agent) d_ �� iz late � a
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 94307-255 TRACT
�. $132,492.70 37 28545-2
JOB SITF�
APN
ADDRESS
'77-362 VISTA FLORA
631-390-072
OWNER CONTRACTOR / DESIGNER / ENGINEER
IZSL DESERT RESORTS, INC. ICSL LAND II (.,0'RPORATION
56440 POA I3L`13J 35-920 PGA BIND
L.A. QUINTA CA 92.253 LA QUM TA. CA 922.53
t (760;)561-7166 CBLO 5323
USE OF PERMIT
.i
PiFAPd' 2t1 -3V - yr, -P, + IT D ES' NOT It�iCi:[.T ).8 Ei'1 K IWALL C R POOL
7sr4.I'I..AN CM -Ci: R:Ft?uC'rtON 4PPC,:I.ED. LA QigmrA. R1.,SORT ROAMS,
PR s�' t
CL11,TrCAt1 C0NSTkUC1':(ON 1,674.00 SF`
1?Olit`i11"PA 1. 157.00 SF
MATED COST Of' COieiSTit�[t�;' ION
;1':32,492.70D
�'Ei�F1Bl'� FEE SUNMIR-Y
FEE
CCONSTRUCI'ION.FEF 10.1-000-41.13-000 $735.00
:PLAN C -BECK 101-000-439-k$ 1l
MF.MANIC} LFS E 101-000421-000 %96:50
RI.irGMCL SEE 3:01-000-420.000 S13 ,a9
PI UMININO ]:EE 1.01-000-4.1949)0 S174.50
S`I'RoNcfxlouaN-Fos-l2.l~3) 101-000-241-000 $1325
GRAD:INO FEE $21,110
1NIMAS1'RU'CtU:RI EFi; 225-t?00-443342 1.0
ART'IN PUB1,1L PLACES - SII: 701-000-2.55-1101) $81.13
SUB -T i3`AL CUNTSTRUC'iION AND PLAN CHECK
$44367.98
LESS PRE -PAID l�EES
TOTAL PERMIT FEES DUE NOW
S4,367.88
RECEIPT
'
DATE
BY !'
xi.
DATE FIN�pr� ED
g' T
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 a�
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:
I
t
_ CITY OF LA QUINTA
!r ° BUILDING SAFETY DEPARTMENT
`6§0ECTION REQUEST LINE
777-7153
l!� 1�9g
Owner 'KSL DESRESORTS INC v V
Contractor G 7� "•, .3 u
Permit Number
9807-255
POST OJOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB A?DRESS 77-362 VISTA FLORA
-PLAN 2A, LOT 37, PERMIT DOES�—
NOT INCLUDE BLOCK WALLS OR POOL Ir'—
TYPE
t—TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL f ��
MAIN GROUND SYSTEMC� y� p_h, La,�
GROUND PLUMBING . v.
PRE-GUNITE c
DO NOT POUR CONCRETE UNTIL 777
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF _
BOND BEAM
O.K. TO WRAP c
GROUT O 4' O 8'
FRAMING 7 �.
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH _
POOL PRE PLASTER
PpOLf ENCE 8 GATE
EWE, SEPTIC TANK -
Z.
FINALS
ELECTRICAL c� .
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING''