0012-172 (PC)LICENSED CONTRACTOR DECLARATION
.q 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 # gqyyLic: Classs7�•((� Exp. Date
�
Date �� � Signature of Contractor �
-OWNER-BUILDER DECLARATION
I hereby affirm under,penaRy 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 exe_ rapt 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.
S c( ), 1 have and will maintain workers' compensation • insurance, as required by
tion 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 00LD CAI tS.&OLE Policy No. to.%4BR5.1S9�
(This section need not be completed if the permit valuation is for $100.001 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,those' provisions,
)ID "ate: �,".r✓ Applicant `� %t�'j�r pf.iaL
1
Warning: 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 insSection 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 8 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 fd'r inspection purposes.
`Signature (Owner/Agent)(&� A, �'"' � "' Date r /
-.BUILDING PERMIT PERMT#
EE
DATE VALUATION : ;g. LOT-++�+'" 72, TRACT
F
JOB SITEr
APN
ADDRESS7tJ.%AV�A�'
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1�.�.:l. DRSE I.' RESORTS WC
X L, DESM RE-S WTS WC.
49-499WERHQW :DR
490,499:F 3�..f"T1,10*101Pik
.I.A Qlmr 'h CA u2253
LA. Qpbnik CA 92?.5:�
360)777-485 ILA :03619
USE OF PERMIT
1?.t�I'Ip
•
462.1I'. - PATIO s~QVY_D AS.Pt-I .rlk'PDTO'tlE0 PLANS 6nd1 Y.
f
C,Oitfl7'SItiS ��B 41R SF
Ra�.'�E:it!f , J0 COST OF C.liNFI`i'tu MC9IR,
6,1 B4AD
P.1.4m CHECK .Ws1, ) Q1-000-439-31 8-
C 14STRLWITION
�lt�O�1`Att3 �l� 1l7'I-CCr�t•� �3�iI{J9 �lv,�a
S1'1•tV?NO MOTIOM 1M csOlirlPA 100-006 2A1-000
I'D
JAN. C
4 2001
�9'. a y
4
ITUR-'ArlAL C"U.a1:Pt42XTMIC7X AMD PI:AA 0D1WK
$164.79 � .s
I "W PRDFAM Erli
$�D.
RECEIPT
DATE f
By�_, t{lY
DATE FINALED
INSPECTOR
A; -• J " .
INSPECTION RECORD
OPERATION I DATE I INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
BLOCKWALL APPROVALS
I Set Backs
OPERATION I DATE I INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts •
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
POOLS - SPAS
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
mnat
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
Test
'COMMENTS:
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility
Au�_ - c,r r r vr- LA wall
BUILDING & SAFIUY
Df.,pbMEND
4 zoos. ,
INSPECTION RE&k* kl- E
y 777-7153 tA (4UI 7
Owner KSL DESERT RESORTS INC
Contractor KSL DESERT RESORTS INC
Permit Number - 0012-172
POST ON JOB IN CONSPICUOUS PLACE '
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 49-499�EISENHOWER
462 S.F. PATIO COVER AS PER APPROVED
PLANS ONLY
TYPE OF INSPECTION
DATE
INSP. ,
FOUNDATION & SETBACK
FOOTING STEED
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS-BEEN
SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN
SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
,
ROUGH GAS & GAS TEST
HEATING & VENT -A/C .
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING -A/C
HOUSE NUMBERS
JOB COMPLETED Mli
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING