9812-238 (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
f$uii B %:�sL6vY17, Wo
ate 61 "6° 10--7 Signature of Contractor-
417
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.
i'•dJ1�1Ci IP11L% w"v'a Cx
1VW1 1111 V1A.^, "
rr Q,.� :•� v.tNi.� i
(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 provisiofnsf Sectio 700 of the Labor
Code, I sqall f • rthwith comply with tiase��isld�s?^� 1'f
spate: Applicant
i .
Warning: Failure to secure Worker s'7 Compensation overage 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
theabove-mentionedproperty for inspection purposes. 1
tsl"gnature (Owner/Agent))-- f..+� �� - � Date 4/_ `.
PERMIT #
BUILDING PERMIT
981Z_23
DATE VALUATION $132.492.7t) 492.711► LOT 19 TRACT 235*i-2
JOB SITE
ADDRESS 77-442 V'1,KU FLORAAPN
631-370-022
OWNER
CONTRACTOR /ADESIGNER / ENGINEER
j �j qq/
I9.�,1$.� ll Y;." 1111 Ai[4. 1%1 �. I. Ll/ 1
/ s
I�81, AND £1. 1.70 ll �.✓i<I IUN
55.910 PGA BL VID
55-920 Kdv E3IND
LAQUINTA CA. 12'2.53,
1.k1 QUIN`1'A CA 92253
USE OF PERMIT'
"
4;1.117111,v'f# 59,1tii,ttJv 2J�. PRM1"A: su W01 1Nc"'t�u1'JI fi1.UC 1'. WALL
I.JR. P001..PLAN (MliCi :9dMitfd.;f~.J) 750110 FOR IM.)t'1d:138VANCfs CW
SAME PLAN TYPE.
W is ONI ,,X_W'.4rR Ui 014 1,6-I I.00 'Ir
i�C;ftC 11*Pi f:lC� 1,57.OU �`F
V�].4 &�s.a�•.,' ;AN V,fRa q,, 1.11,114 b. 1.11, 1114
�J4g47.p,•10
FAgg�gR E STT IMAA psgw,.s
CONSTRUC t ION # E A01.4011-418-000 3755.00
1't.AN (•`i•')VCK H FF t 411.-(ia111A14-11°3 S1150,1111
MCORA:MWAL FEF 10t-000-421-000 $93.50
kLC(,` RtC AL VE8 101-'M-420.01130 $131.09
PLUMV N01 M 101.-000.419-000 $174 30
57 it. JAtcr'E41/.7 ()j�7 i °S*i? - F 1,;ClJI I111 -M(2 -?41 AM $ 111 ?5
GRADING 31T 110.1 1140-41 _"rp saa.f�
INW,tiLASTRUCTUIRE M,. 1,, 25-M-44-1,342
AXF IN Y10BL)C PLACE -S -'RFff Sll, 701-01CxJ-253-000
S i%t-"IYY6', 1, a,''f 1N�r'( Fit f4'T'?<t3A1 +?W) PT.AM r4114 "k
9�.i tfs7 Nttt
I,ESS 1)R1-IIA.ID FEE :S
$10.00
WA.t L 1'.l+;.1AA0'f Y KES 0110 NOW
54,367M
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
v
Ducts
Forms & Footings
_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
F.A.U.
Compressor
�C
v_l
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Party Wall Insulation
Fans & Controls
Condensate Lines
Party Wall Firewall
Exterior Lath'
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
o
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-66
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) �liZ�
COMMENTS:
..m
Certificate of Occupancy'
City of La Quinta J
Building and Safety Department FM0Fti
This Certificate issued pursuant to the requirements of Section 109 of the. Uniform quilding Code,
certifying that, at the time of issuance, this structure was in compliance with the, various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 77-442 VISTA FLORA
Use Classification: SFD . Bldg. Permit No.: 9812-238
Occupancy Group: -133 Type of Construction VN Land Use.Zone: RM
Owner of Building: KSL LAND 11 CORPORATION Address: 55-920 PGA BLVD
City: LA QUINTA CA 92.253
By: KIRK KIRKLAND
Date: 3-14-00
Building Official
POST IN A CONSPICUOUS PLACE
Mon