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9812-233 (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 r Date - 411A� Signature of Contractor �,1, 4 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: 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). 1, 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' comp . ensation, I as provided,for by Section 3700 of. the *Labor Code, f6r the performance of the work for which this permit is issued. (V ) l.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. (This section need not be completed 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 I should become subjectio the workers' compensation provisions of Section 37OO.of*the Labor Code shall,forthwith comply with tho revez pate: 64,4_A,,t Applicant— Warning: Failure to secure Worked' CoEppensation co erage i S 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 appli6ation. 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 "n pectlonmV3S. A1_1 .Signature (Owner/Ag 9' Date D"t 4 BUILDING PERMIT PERMIT" DATE f VALUATION sqn.492,7o LOT -54 TRACT 121,3545-7 VISTAFLORA I OWNER 35 -9-2.o xwt AL VD LA QWNTA' CA 922-53 APN .631-370 -022 - CONTRACTOR / DESIGNER / ENGINEER .03L by I kbrID II C011VOM710 tHT 555-9240 PGA SiND LA%f.1'NTA CA 912253 (760)*- 1-71M 041141 5371 USE OF PERMIT STNOU3 RKMILY DWEL(ANG LOT4 54, PLAN 2B. PEMWTtic ES 11101 INCIARY813i.&WWAILL Oft POOL.'P1,AN Cfft-AX, FEE, REDUK.W 75% FOP, W11. 1SUi%10E OF* SAME PLAN TYP& F cu'vorvil CON-1-311RUCTIC17N t.674.00 S1 E13TIMUT1,1119 cog", Or, CONSTRIXTION F0. 101-000-418-000 M, AN r,'W2, C 9 F f '�R sf 60,2-1 &=I-WItCAL.Pma 1014=421-000. $98.50 Ef,6CTr01CALFM,` 1 QII000420-000 S1.31 .0 101-000-40-000 $ 174.50 ST RONOMOT10. N VIER - R6810 4 ekl A.0.rN(31`.FfX 110_1-,000'423-000 W11.00 JN M-A�IYFRUCTUW M '225-00-443-342 $2934.10 .AR'f IN PUALICIA,ACTS -, RMIC 70-1-000-255-000 4DTAL Q 1, RIJC. XNAND PLAI CHECK LES'S PRr,-PJVD FEES RECEIPT DATE BY' DATE FINALED INSPECTOR $4,367.88 . $0.00 $4j367.89 t INSPECTION RECORD OPERATION DATE INSPECTOR BUILDING APPROVALS Set Backs Bond Beam Forms 8 Footings _ L Slab Grade _ t Steel Roof Deck Final O.K to Wrap —� Framing Waste Lines Insulation Water Piping Fireplace P.L. Plumbing Top Out Fireplace T.O. Shower Pans Party Wall Insulation Sewer Lateral Party Wall Firewall Sewer Connection Exterior Lath Gas Piping Drywall - Int. Lath Gas Test GCS OPERATION DATE INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Condensate Lines Final -Aez< BLOCKWALL APPROVALS —v 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 Test GCS Appliances Final COMMENTS: Final Utility Notice (Gas) _ Qj ELECTRICAL APPROVALS Temp. Power Pole Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) ;� •-.r/d .Sent By: KSL; 5551212;: Mar-8-00.11:36AM; ',Page 3/3 CITY OF LA QUINTA ► TY? DEPARTMENT , BUILDING; & SAFE'_ i 777-7012 INSPf�b71ST LINE ' KSL DF-SIERT RESORTS, Inc owner. KSL LAND 11 CORPORATION Contractor 9812-233 permit NumberPUO. US PLACE POST ON JOB IN t ALL APPLICABLE INSPECTOR MUST 77480 VISTA FLORASPACES y.. J08 ADDRESS SFD, LOT 54, PLAN 2B. PERMIT DOES NOT INCLUDE BLOCK WALLS OR POOL , DATE INSP. TYPE OF INSPECTION FOUNDATION&SETBACK FOOTING. STEEL" MAIN GROUND SYSTEM'r 9 , GROUND PLUMBING PRE -GUN ITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN S ED CONCRETE SLAB JOISTS & GIRDERS ELE Tf' RICAL GROUND WORK . DoT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST L HEATING & VENT - A/C FIREPL CE ROOF BOND BEAM O.K. TO WRAP f GROUT - ❑ 4' ❑ 6' FRAMING C _ INSULATION PRE -ROOF ------ — COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL. PRE PLASTER g©OLfENCE & GATE _ Y SE FINALS ELECTRICAL PLUMBING FIN"' . GAS TEST H, 4G -A/C HO SE NUMBERS JOB COMPLETED TEMP POWER T. INCLUDE RIGHT O ABOVE APPRON UOV L 7 ES NOOCCUPY BUILDING