9807-256 (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
p/ate �' % Signature of Contract
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:
O 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 c ¢a 11�,Et I, Policy No. i gA
(Th'is;section tn�Je"d'hbt'p�e�Cor�r�lete�d if the permit valuation is or�$T� . 00 less):
O l certify that in the performance of the work for which this permit is issued,
I shall not:employ any person in any mariner so as to become subject to the
workers' compensation laws of California; 'and agree that if I should become
sleici to the workers''compensation provisions of Section 3700 of the'Labor
C de, I s 111 forthwith comply with`i`hse provision .
Applicant %I"
Warning: Failure to secure W rkers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,0001 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 herebymade 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, & sliall, 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
thZat
above-mentioned property f. r inspection purposes.
ure (Owner/Agent).
,�i:. , w Date/ ;�''?
BUILDING PERMIT PERMT#
DATE VALUATION LOT 907-256 TRACT
8119l�1A 599.341.110 38 18545-2
JOB SITE ,
APN
ADDRESS
77-179.112 VISTA FtA)RA
631.•366.072
OWNER CONTRACTOR / DESIGNER / ENGINEER
SL DESERT RESORTS, INC. KSL LAND Ir CORPORATION
56-140 PGA BLVD 15-010 PC BLVD
LA QliI9i'1•l . CA 94253 LA QUINT.A , CA 92253
(7(0)564-71,66 C13L# :532.3
USE OF PERMIT
PLAN 3 - SFP, �- PERNHT DOO iso r MCtiUDF,13LOCK WALL OR t 00L.
75% PLAN CHECK'KWLICTION .APPI IM. LA QUWA 1ZF'3OWf ffOMES,
rr
CUSTOM Cva3,5'1'.tI:I1M'1014 / 934bD SF
POACHlPAT110 45.00 SF
GARACfF1r.;ARPOR'1' 1;190.00 'iF
; ,5•' 11%4X17E'1) CO. Tf OF CONSTRUCTION
99,341.1191
PERMIT FEE SIJii MAW
C ON.1;TIRUCl'ION FEE 10j.000-418-000 �4►3r). SCi
PLAN r`IiI~C CHECKFEE X01, 004.439-313
MECHANICAL M ' 101 -OW -4121-000 5 3.50
8Y1Wr,PJGAL FEE 141.000.420-000 5104.99
PLUNIBINO FEE 101-000-419-000 813 .00
T!'.1tONO MOTIGN FEE _ 12,4:5ID 1014 0-241.000 53.93
GRAWN6 FFA 101-400423-01M S'�U.OSi
TNV kAS7'12iJ4"`P41EZI•s,1" 225-000-443-342 4i^a,1G3.;f3 i
Al
SLI13:TO'I'.AJ CONSfRUC7riOD1,AND PLAN CHLCK
$3,158.50
sSS :flit PAM FEES
$0.00
T01rAL PERMIT FEES .DUE NOW
53,,2159.50
totem as a
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
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
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 Pibg. 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)
COMMENTS: