9807-244 (SFD)t 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 7i 0 13 $30
ate �� Signature of Contractor , 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).
( ) I, as -owner of the property, am exclusively contracting with licensed
contractors ',to .construct the project (Sec. 7044; Business & Professionals
Code).
O I ani' exempt. under Section B&P.C. for this reason
Date ^� Signature of Owner
r
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.
O 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: Myworkers' compensation insurance carrier & policy no. are:
Carrier. Policy No.
(This section n e otJbe o p eted if the •permit valuation iso $100.�� o'r 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
subjrect to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with -those provisions. '
"Date: �'l Applicant1-, i A�
Warning. Failure to secure Workers' 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 pursuantto
any permit issued as a result of this applicator 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,,u6'idif
work is not commenced within 180 days from date of issuance .of s h
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.
vSignature (Owner/Agent) �f�/��L�, Date 1/'
BUILDING PERMIT PERMIT #
DATE % VALUATION LOT 9807-244 TRACT
r G f $.32d49,2.70 40
JOB SIT ' X
iP
ADDRESS
77-414iVISTA IMORA
n�i� �l0-Qi2
OWNER C.,
CONTRACTOR / DESIGNER / ENGINEER
KSL DESERT RESOR'T'S, INC.
liSL LAND it CORPORAMN
36-140 POA BUM
55-920 PGA GLA)
UV QU'INTA., CA 922.53
1.:4j. QL8'NTA CA 92253
t;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —
Underground Ducts
Forms & Footings
Ducts
Slab Grade2
7W
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
Framing
F.A.U.
Compressor
Insulation LVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
*Party Wall Firewall
Exterior Lath 2- 7 .-cr
Drywall - Int. Lath -L
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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 — Z
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) -•7;1 N-7-cl
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