9807-252 (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
.
! , # :
tf0ate. Signature of Contractor -
OWNER-BUILDE DEC ARATION ,
I'hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following, reason: . .
( ) 1, 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:
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':co_mpensation insurance carrier &.policy no. are:
Carrier PolicyNo..
71 gd'fC' Ct j' �i k'.'. '►w. 3 f 1
(This section'heec�-4 Ne i�ofr�pleted,if the permit valuation Istors$�il .b� or less),
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 1 should become
subject to the workers' compensattep provisions of Section 3700 of the Labor
de
C , 1,5 a11 forthwith comply with those provisAs.+
te: % 6. Applicanca
t/rc
�.
Warning: • Failure to secure\A orke s' 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.
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
th�bove=mentioned proper4rfor inspection purposes.
f,�J
,/Signature (Owner/Agent)%Or Date 7 7
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9807, 2;52. TRACT
'
13E.d92.7!) -34 28545=2
JOB SIT a
APN
ADDRESS
77JIN VISTA FLO A
611JR11-072
OWNER CONTRACTOR / DESIGNER / ENGINEER
KSL DESERT RESORTS; INC. KSL LAND 11.CORPORATION
-140 PGA ] LVD 55-420 PGA BLVD
LA QUINTA CA -02253 LA'QUINTA. CA 92253
(760)564-7156. CBL-# 5323
USE OF PERMIT
PLAN 2A - SPj-- PMOT iDOES NUr INC`T:11DE .`BLOCK WALL OPL POOL.
75% PLAN CUECK REDUCTION APPLIED. LA QU1NTA RESORT HOMES,
7 A g
f
C"U.S:CON11 C_0 $TIt•U rar1O-N1,674.8X) V
POR,p `?/PAT:IO 157.00 Sf+
ETI:ti A E1�. 'flS`C OFL'OfV .ax tii�c �1vl�
13 2,492.71)
PERMIT FEE �WMKILRY
CONSTRUC11TON FEF 101-000-41.&000 $755.00
ESi�AN i,7 CiS PEE. 101-1800-439-318 $160,21
,l CFi.�Y�1CAt, 1 t01-000421-00.0 v u
Ef~hC1klOAY lily' 1.b:i�000-420-000 $131;9
PLUXIIB)'Att*1.1 EF 101-000419-p00 $174.50
STRONG MOTION FEE -• RF_- ]D 161-000-241.01010
GRAD. KA OFER 101.000-423-0100
WRAS 1 RUC"1'`it W R99. 2'25-OUO-444X34'2 5 !34.10
A:RT't'N PUBTACPLACn,IT —PRF303- 701.-000-2.55-000 S$1 23
•.
SUB-1YYi AL C{7'NS'! RUCTION J ND PLAN CHECK
$4,367.88
I. -PISS Mr. -1 -AID FE, ES
$0.00
'T(:1'I'AL PERMIT FELS DUE NOW
34,367.88 ,
x
RECEIPT ,
DATE
BY
DATE FINA ED
INSPECTOR
r
5-a% 9
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
0. 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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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
COMMENTS:
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)