9812-239 (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
747�4 j
�p!%te ` / Y4 Signature of Contractor
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).
( ) 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:
Carrier Policy No.
U"\\~T +i711r1/ t Mli4'L \r is�gthlRG
Vi� kfe5J�1 }'k) Nj.
(This section need not be completed if the permit valuation is for $100.00 or 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 t j enpr�ovsl �n J46te: / , Applicant—
W,
Warning: Failure 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 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.
VS/Ignature (Owner/Agent) :Z- f Date &Z r l
BUILDING PERMIT PERMIT#
I
DATE
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VALUATION,LOT TRACTJOB
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USE OF�,��PERMIT
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RECEIPT
DATE
BY "�
DATE FINALED
INSPECTOR
i
a
3 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
OILExhaust
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
` C1
Final
Final —ev
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 . ,
hower Pans
O.K. for Finish Plaster
ewer Lateral
Pool Cover
ewer Connection
Encapsulation
Gas Piping
Gas Test
2-/ . CU
Appliances
Final
Final Ga
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 Gy
Utility Notice (Perm) Cp
COMMENTS:
4
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v CJS frs � .It
P.O. Box 1504
73-495 CALLE TAMPICO (760) 777-7000
✓;Y' LA QUINTA, CALIFORNIA 92253 (TDD) (760) 777-1227
February 25, 2000
RIVERSIDE COUNTY ASSESSOR'S OFFICE
3255 East Tahquitz Canyon Way, Suite 114
Palm Springs, CA 92262-6962
To Whom It May Concern:
Please be advised of an address change for the following structure. The structure
formerly addressed as 77-434 Vista Flora, underlying APN: 631-370-022, Lot 52, Tract
28545-2, the constructi.o.n_for_whch building permit #9812-239 was issued, will now be
addressed as 7 38 Vista-Flora./(This address was a duplicate.)
Please note this change and contact me directly -at (760) 777-7012 if I may be of further
assistance.
Thank you.
Sincerely,
Greg Butler
Counter Technician
BUILDING & SAFETY DEPARTMENT
Al
ASent By: KSL;
5551212; Mar -8-0.0. 11 :35AM;.
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
�+ 777-7012
-' INSPECTION REQUEST LINE
"
777-7153 ;.,, ?
Owner KSL DESERT RESORT
KSL LAND 11 CORPORATION
Contractor '.981 -2 t4
Permit Number PLAC
POST ON JOB 7 _E SPACES
INSPECTOR MUST: 7-438 Vista Flora =.E
JOB ADDRESS
SFD, LOT 52, PLAN 1. PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION
oATE INSP.
FOUNDATION & SETBACK �(
FOOTING STEEL
MAIN GROUND SYSTEM cI
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL AL ABOVE HAS BEEN NED
CONCRETE SLAB
JOISTS & GIRDERS
ELF�TRICAL GROUND WORK
z .J 1 as
DO OT UR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS &GAS TEST
HEATING 8 VENT A/C
FIREPLACE :.
ROOF
BOND BEAM
O.K. TO WRAP,
GROUT O 4' ❑ 8' "
FRAMING
INSULATION
PRE -ROOF`.
COVER NO WORK UNTIL ABO HAS BEEN SIGNED
` DRYWALL INTERIOR ,- �...
EXTERIOR LATH
POOL PRE PLASTER
• POOL FENCE &GATE � �- . ` , .r'� G.
SEWER SEPTIC TANK
FINALS
ELECTRICAL .
PLUMBING
a FIN . GAS TEST
H. JG A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING,
Page 1
4.
.ofCertificateocc
upanc ,
Cit-�.
Y of La Qu
inta -
Bd
ildin and SaDepartment cOg fety ti
F �
.This Certificate issued y
pursuant to the requirements of Section 109 of the Uniform Bui/din Cod
certifying that, at the time of issuance, 9 e,
this structure; Was in comp/lance- with the various ordinances
of the City regulating building construction or use. For the fo/%wi
BUILDING ADDRESS:,3S -
77 -434 -'VISTA FLORA
Use Classification: SFD_
Bldg. Permit No.: 9812-239
.r. Occupancy Group: . R3 -
Type of Construction: VN Land Use Zone: TC
Owner of Building: KSL LAND 11 CIORPORATION
Address: 55-920 PGA BLVD
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
' Date: 3-9-00
Building Official
ALL---
POST IN A CONSPICUOUS PLACE