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9807-249 (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. I�1":f1ii 13 ; 4130/00 Da' to/1 4 �Signature of Contractors - OWNER -BUILDER DSL/ARATION I hereby affirm under penalty of perjury 016t 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). ( ) 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: Cartier Policy No. (This section eleJnot�6e co` peed if the permit valuation isfo X10 00 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 Code I shall forthwith comply with those provisions. Applicant Warning Failure fo secure Workers' Compensation coverage Is unlawful and Shall subject an employer to criminal penalties and civil, ines 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 pursyy�Vto'� any permit issued as a result of this applicaton agrees to, & shall, ini X, . & hold harmless the City of La Quinta, its officers, agents and employee 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 eaabove-mentioned property for inspection purposes. Signature (Owner/Agent) f % / Date A"'. BUILDING, PERMIT PERMIT# ^ DATE VALUATION LOT 9907449 TRACT $136,872.00 31' W15-2 JOB SIf 7 H'6 APN ADDRESS 77-401, V]:'�7'A.FLORA I 631-384.072 OWNER - CONTRACTOR/DESIGNER/ENGINEER KSLDfiS- .E.PT 1ZtSORTS, INC.' KSL LAND 11 CORPORAMON 56440 PGA,BLVD J? -9-20/ PCtE# )3L VD LA QLITNTA. CA 93253 LA QUINT -A CSL 9225- ('160)564-71616 C.BUff 5.323 USE OF PERMIT Owe t � c PLAj4 4D ALT . qF> . PFR:1 I C DorIS T o -e 1N(-LiTU1r BLOC % WAi i. OR POOL. 7-V/�;'PI,AN Cf CK :RF�l)UCTION PPL:tW, LA Q1HNT.A. RE.S0RT r-iAX4,1 PRAR117 CiJS'fOAR CC1'N '.ti'tllCTi a�! l,680.Ut1 SF EST11NIAT D CMC OF COrrSTRUCTION 13018"1 2.00 PER: f ff FEE SUI%& ALRY CONSTRUCTION 101,-000- i1&000 $74801 PLAN CIECK FEE 10.1000-439-318 $160.15 NEC`HAi51tCAL FEE 1.01-0,0 42,11-000 $137.00 t Rc�1°la1CXL k':1% 101-000.420.000 rel fr fVB NG FES, 10.1-100419-000 �lfa'9.75 STRONG NOTION FEE - RES1D 101-000-241=000 -$13.09 CR AD''ING FEF 101-000-423-000 520,00 illr''d�A;i`CR.UCi'�RRI!'u 33s-CIZ- 43-34 $2,944,62 ART IN 111181,1C P1,ACTS - tASTC 701-000-255-000 $77.13 M rJ fl C> I ~ SUBVIY) AL, C ONS`1 RUC11©N ��NU' PLAN C HECK u4,3Sfi.0`�. .. s LESS P1tB TOTAL PERMIT 1!'� •` DUE NOW $4,386.09 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & FootingsDucts 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. Gnils Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath <7 - 7 CIL 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 Test5--ZZ—f�M 46L Appliances Final Final 42m— 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) - 3 COMMENTS: