9812-232 (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 # .,Lie Class `, Exp. Date
r� �t p
11i 18,13 1 `�i 30100
b6ate � Signature of Contractor
OWNER-BUILDE6ECLARATION
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 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 f/Yeee't Ap,77�,r�n'�Y n����1// Policy No. r,r wgspa�nyd �.}
I_,(✓",2.�CH /,lrSW1�.t1L Qsl :Yl �J i3,16 07
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the. performance of the work for which this permit is issued, .
I shall not employ any person in any, manner so as to become subject, to the
workers',compensation laws of California, and agree that if I should become
subject io the workers' compensation provisions of Section 3700 of the Labor
Code, I s al forthwith comply with thos� sio
ate:
Applicant—
K.
pplicant ,��$a�
Warning:. Failureo secure Worker' C
sompensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to'$100,000,.in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. .
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions, and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at .
;whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City'of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and, void if
work is not commenced within 180 days from date of issuance of,such
permit, or cessation of work for 180 day's will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct: I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives. of this C_ City to enter upon
theeaabove-mentioned property for ins et
/J upz� iw/2
Signature (Owner/Agent)Q,,,- is oY._. Date
BUILDING PERMIT PERMTN
DATE VALUATION &I M),,R71:�13 LOT S� TRACT 213545-2,!
oT"
i
JOB SITE
ADDRESS 77-�?` 3 119CA �!: 5_a
APN 63.1-370-022
OWNER
CONTRACTOR / DESIGNER / ENGINEER
i,\.4'Si.. f...f"F.tV 1✓ L� �:.r'!.�i\l. �.�1R1�.R 7.Ly.6�i
Ir AAT'Yh
'.11.M3r !w.!":.IV A./.l.fa e\sloltro�,All Rt. e -
n
y574211PGA Bx. tV—D
335-0109 Pl:�'.EY KNO
E.,A, QUINT`,A, CA 92,253
LA. QUINT'A CA 92253
I
Q(q)SH4- 106 01.31 C 5323
USE OF PERMIT
yf,U. LGT7- 53, PL.AN jai? -tie t PaMiT D09S NOT''T:Ncu{:t���t3Lo K
SEAL}. OR 1KWI PLAN 4 *ktEC K 4W t.WDUCiM) 750X,'3 Olt:wT (R4x.
q$Uea;L GF 0 S gW191?1 A `NPj~, z
cu'i`9 om C:aN aum�C"i'te:'7i
t
.COYIP 01111 wNS"t RiITION
130,872.40V"NAUM .
dffiElw nu." VJyNly'ow
COAT: 't'RIA f ft' N PEE 101-00418-000 $748.00.
PAN OW -C19 ITE",
NiSC.14MICAT: FM 10 1-000-42.1,000
FIE CIATC AL TU 8 dGf-t}60.d�U�}UA $I]G:3ti
P1 UNIBNOFps 101-100-4.14-000 ��iJC►,7
��,�z�>ds� ��°r��� r� . st�s� zn�.-�tlra��a�>I-�>7n �4z.4►�
CM AD' 0=3 101.„00.4211a00 $20.00
Im" STIoic"IC' i ru,- '225-000.44-.W, $2.944;62
Af r fATPtJsue :RL.AcEs-.rdv-s ; 7()t.-oo0-255-000 577.:15
INA �'.aaV ";I"
LESS :PRE-PAIDFIE- S
TOTAL PEIRMAT FEESIVE, NOW
;w
�.0
RECEIPT
DATE
BY.'
DATE FINALED
INSPECTOR
F -
INSPECTION RECORD
OPERATION j
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
-
Exhaust Fans
O.K. to Wrap
Framing
_
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
7.
Drywall - Int. Lath
- p_
Final
. Gti
Final Gu
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
OX for Finish Plaster
Spwer Lateral
Pool Cover
S r Connection
AA7
Encapsulation
s Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) _per
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 - G(•) K
Utility Notice (Perm) l - w
COMMENTS:
G
Sent By: KSL; +5551212; Mar-8-00 11:36AM; Page 2/3
,CITY OF LA QUINTA
BUILDING &SAFETY DEPARTMENT
^ '
-.O, 1 777a012
INSPECTION REQUEST LINE
777-7153 .
KSL .DESERT RESORTS, Inca I
pruner RA ON
Contractor -
permit Number ':NSPIC000S PLACE
POST ON J08S LICABLE SPACEScc
INSPECTOR INS MUS_
JOB EL� E iT DOES
• .NOT INCLuDE BLOCK WALLS OR POOL
DATE INSP.
r TYPE OF INSPECTION `�w
FOUNDATION & SETBACK
FOOTING STEEL {
MAIN GROUND SYSTEM G(
GROUND PLUMBING
PRE-GUNITE
DO f10T POUR CONCRETE UNTIL ALL ABOVE H BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELFrTRICAL GROUND WORK
D-Oo T POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING -
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
5
ROOF
BOND BEAM •�
O.K. TO WRAP
GROUT ❑ W O 8' /
FRAMING
INSULATION
PRE-ROOF -
COVER, NO WORK UNTIL ABOVE'HAS�EN SfGNED
DRYWALL INTERIOR ,� Z
EXTERIOR LATH
POOL. PRE PLASTER
L FENCE & GATE
S R SEPTIC TANK
FINALS w
ELECTRICAL'
PLUMBING.
FIN"' GAS TEST
H, JG=AJC. i '•
HOUSE NUMBERS '
r J08 COMPLETED
TEMP POWER
3
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO'
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy.
4
Cityof La Q,uinta..
Building and Safety Department�oFti
This Certificate issued pursuant to . the -requirements of Section 109 of the Uniform Building 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 .fol%wing: ,
BUILDING ADDRESS: 77-488 VISTA FLORA -
Use'Classification: SFD 7Bldg. Permit No.: 9812-232
Occupancy Group; R3 Type of Construction: ' VN Land Use Zone: . TC
Owner of Building: KSL LAND 11 CORPORATION Y Address:. 55-920 PGA BLVD
City: LA QUINTA CA 92253.
By; KIRK KIRKLAND
' Date: 3-9-00
Building Official
POST IN A CONSPICUOUS PLACE