9807-246 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty ofipertury 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
di, 866
7 41"30
Date ���' Signatureof Contractor ` i A, � • r
OWNER-BUILDER/DECLARATION
I hereby affirm under penalty of perjury that'] 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 proffered 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
t
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.
( j 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.
R CTf�IC1'�(�i[)12rCfs
his section nee o1 be cpm eted If the permit valuation is for $100.00 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,l should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Cgde, I shall I forthwith comply with those provisions: r
ate:_ Applicant `
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 pursuantjo
any permit issued as a result of this applicaton agrees to, & shall, indem I.
&" 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 i#�
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.
ti ignature (Owner/AgentDate gZ.% -=1
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9807-246 TRACT
I/. �/ ._ � $195,449.20X12 213545-2
'11JOB SITS � �%
APN
ADDRESS
-77-426 VISTA. �+ L.O A S
0 -390-072
OWNER
CONTRACTOR / DESIGNER / ENGINEER
K.SL DESERT IRESORTS,1NC.
L:SL LAND 11 C:GY.i't3FCtMON
56-140 PGA BLVD
55-920 PGA.&NM
I;,A QUINTA ' C.A. 92253
LA. QUINITA CA. 92253
(760)564-7166 CBL# 5323
USE OF PERMIT
D-0 e. e. � I t4
PLAN 3 - SFPi - P}=P.MT DOES NOT M(MUDE,13LOCK WALL GR POOL.
LA QUTNTA RESORT:HOWS, PHASE 1. 52:5(1.00 PLAN C..FiEM DFIP ?SIT
11S�ia -Y
4 U.T.17 M CONSTRUCTION 1391.00 $F
i�i�RGr1�PEi1`IZ) 691.00 Sl
C�
CI S�'IMATED COST OF CONST0 11 04 3
595,449:211
lta'ERAUT FEE Si11L1<MAERY �
CONST RUC1'ION FEF 101-060-<119-000 �� $975.50
PLAN CEIECK FSE i t11-00¢ 4 )=31 $811.91
1tiiK14AN1Q 1. FEFC1 X121 -M $115.00
F1:EcrKlCtlL I d -a20 $14t.;f9
PLUMBCNGi.FFTi. 1010-413-000 $196.50
STRONf3 MOTION FEE'SRESID 10.1-000.241.000 $19454
ORAOING.FIM 10.1-000 423-000 $.2€►.Of1
!NhU3 f ftU4 ffi.ft; P08. 2`1' 5-t�{}1` 443-342 $4,190:83
ART INPUI3I.1C 17t l�t1 H-, '7014)00-'255-000 $238.42
.
F r 01031T 101-M-439318 4150.03
e'f
SUB -TOTAL CONSTRUCM0111. AND PLANT C'Flk.i:K
$6,714.09
LiiSS P.1? r-.1aAtG FIYi1S
4250.00
TOTi%L.PERMYf 1ETt)S DUE NOW
56,464.09
'RECEIPT
DATE
BY '''
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
9LUnderground
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
- 5
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
I 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
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) Af
COMMENTS: