9707-028 (RC)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.
f License # Lic. Class Exp. Date
Date Signature of Contractor
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 .
C.o tractors to construct the project (Sec. 7044, Business. & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date -7 / r 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
Sect on 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. WCGaq(0505"
ZUete-A lNS. CO
(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 provisions.of Section 3700 of the Labor
(bode, I shall forthwith comply with those provisions.
ate: Applicant
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 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
t e above -mentioned property for inspection purposes.
Signature (Owner/Agent) �'fDate
BUILDING PERMIT PERMIT# CONTROL## ,
-5 6 2
DATE VALUATION LOT 1707-028 TRACT -
7 7M37 S1001M.00
JOB SITE
APN
ADDRESS
A_A99 t.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KSL DESFP T RESORTS INC
OWNER dba L.A. QUINT.A. RESORT & CLUB
56140 PGA BLVD
49499 'EISENHOWER. DR
LAQUKrA CA 92253
LA QLMJTA CA 92253
{70)564-7690 CUM
USE OF PERMIT
ZRAO F07 P "RA41T FOR V01, NTAPY Sr-MAOC Rs"I'itC IF17'
LOBBY, SAWA ROSA 1.01NI G, K REQ STRATION, RESTROOMS.
VALUATION 100,000.01) L.S
LSTIMATIO) COST OF C0 STRUCTION
10100t)dt11
JPIa:RMIT FEI. $UAIMARY
PLAN CWfi CK FEE 101.-000_139-A18 1490,00
TOTA1,. CONMUCTION .AND PLAPJ CHECK
$4%.00
1g0 USS PR&P'Alf) FEES
$0.00
o $
�VL
11'fJTAL, PERMIT FEES DUB: NOW
SV".00
fit`0_1
�F7`nt�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE 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 Wail Firewall
Exterior Lath
rImAmil _ Int I ath
BLOCKWALL APPROVALS
Set Backs
PLUMBING APPROVALS
Shower Pans
Gas Test
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Tem. Use of Power
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 I
POOLS - SPAS
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underaround Piba. Test
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaste
Pool Cover
Encapsulation
Final
COMMENTS:
F' final
Utildy
op OF LA QUINTA
DING & SAFETY DEPARTMENT
,C( OF 1 777-7012
G� . SECTION REQUEST LINE
11M-7153
Owner KSL T RESORTS
Contractor ER dba LQ RESORT & CLUB
Permit.Number 9707-028
'POST.ON :JOB IN CONSPICUOUS PLACE '
-INSPECTOR MUST SIGN.ALL APPLICABLE SPACES
JOB ADDRESS . 49-499 EISENHOWER DRIVE
VOLUNTARY SEISMIC RETROFIT - LOBBY,
SANTA ROSA LOUNGE, REGISTRATION,
RESTROOMS
FOUNDATION & SETBACK
MAIN GROUND SYSTEM
�GROUND PLUMBING
E-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