9804-120 (CONR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
,Ch4pter 9 (commencing with Section 7000) of Division 3 of the Business and
�Vrofessionals Code, and my License is in full force and effect.
1 License # Lic. Class Exp. Date
kDat rT' i Signature of Contractor
OWNER -BUILDER DECLARATION f
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:
( ) 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 Policy No.
(This sectizxffucu Itco Wc on need not a completed if the permit valuation is for 019 .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 370Af,,the Labor
Code, I. shall forthwith •omply with those provisions. J)
Date: 1 } 1 �r •;Applicant /
Warning: Failure to secure Workers' Compensation co erage 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 cessatibA 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,6ity to enter upon
the above-mentioned property for inspection purp d s. ,_� J /
'Signature (Owner/Agent) `�C✓--t Date
2 -
BUILDINGPERMIT PERMIT# �CONTpROL'# `
DATE 1 VALUATION LOT 9804.120 TRACT 71ptg�3
JOB SITE
APN
ADDRESS
90AW41 i'V V R A
74 -03"1-1173
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KS'L LAND III
KSL DEVPLOPM NCCQPLP
5- 140 Pl3A BLVD
_56140 PG- A BLVD
LA QUINTA CA 92253
LA QI. DrrA CA 92253
(760)771-3042 CBL4 4676
USE OF PERMIT
a
R[711 ?T;G
POOL BUTI.L11NG & RE,S`i72OON-4
'PRAC'f CONSTR.I.fG" 1'1ON 324.00 SF
E18,11MATE E0 COST OF CONSTRIX-110N
#7,S!l3.ltt
PERMIT VEE S[T11INLkRY
PLAN CHF.C.K FEE 101-000-439.318
CONSTRUCTION FEE 101-000.4113-000 S1f35.fk►
F.L.ECTRICN FFE 101-000-420-000 $39.98
PLUNIBI O FEF 101.000-419-000 $75,00
STRONG NIOTION FEE - "Ri?SID 101-000-2.91-000 51.76
INFRAISTRUC1URE FEE 225-400143.3=12 $395.134
0
PA IIf-T(YrAL CONS RLICTION1 -AND PLAN CHECK
$92.4.44
LESS ME -PAID FEE$
$000
APR 2 8 1998
TO A1. PERMIT FEE, s DITE NOW
5824,44
.CITY OF LA QUIN-158-1
/
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
_
Forms 8 Footings J 1
Slab Grade
Ducts
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
BLOCKWAL APP OVALS
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 -,5—
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) 7 /
ELECTRICAL AP' ROVALS
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 p
Utility Notice (Perm)
COMMENTS:
Coa&el%a Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext. 235
This Box For District Ilse Only
DEVELOPER FEES PAID
AREA:
AMOUNT: $ RCPTA
CIG q: GASH:
INITIALS: DATE:
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: PCA West Date: April 28, 1998
Owner's Name: KSL Land III, La Qui nta Phone No. (760) 564-7166
Address: 80-000 Riviera, La Qu i nta , Ca 92253
Project Description: Pool Building and Restroom
APN: 761-080-073
Type of Development:
Tract #•
Residential Commerci
Total Square Feet of Building Area:
Certification of Applicant/Owners: The person signing certifies
wider penalty of perjury and further represents that lie/she is autorluzed
Dated: April 28, 1998
Signature:
Lot #:
XX
324 Sq.Ft.
behalf of
Industrial
is correct and makes this statement
******%*******************************************************************]******************
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WELL BE
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE):
Z
ov. Code Gov. Code Project
3080/65995 65970 Approval
C
Number of Sq./Ft. 324
Amount per Sq/Ft. $ .31
Amount Collected $ 100.44
Agreement Existing
prior to 1/1/87
Note:
By: Foch "Tut" Pensis Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Elsa F. Esqueda Signature:
FdCllities Analyst
Not subject to fee
requirement.
N(MCtE: Section 66020 of the Govenunent Code enacted as Assembly Bill 3081, set forth as Chapter 549, Statutes of the State of Califontia.1996 effective Jmh. 1, 1997, requires that this school district provide a written notice to
the project applicant at the time of payrneit of school fees, ntitigaton payment or other exactions. This notice is to advise you that any protest ui regard to such amounts or the validity thereof bt accordmtce with Section 66020
of the Govenuuet Code and other applicable law, conunences with such payment or perfon mice of any otter requirement as described in Section 66020 of the Govemmet Code. Additiomally, this notice advises that to
protest thereof must occur withbh 90 calendar days thereafter.
Note: AB 2926 and SB 201 fees are capped at $1.84 per square foot for all residential construction, and at $0.30
per square foot for commercial/industrial projects.
Dev. Fees Disk: Misc\Cert-ComSarn. (REV. 1/97) -
Cityo La Uinta r
Developers Project Approval, Form ,
Prior to the issuance of Building Permits for the project listed .below, the following Departmental .
clearances, must be obtained.. Please return this form to the Building and Safety Department only
after approval. Contact applicantfor'resolution of conditions preventing or dea in approval.
Project: Pool Building
PGA West, (80-000 Riviera)
Applicant Contact: Roger Hobbs, KSL Development Corp., 564-7121
Applicatio / Circulation D e:' L
Date
Community Development Department
Christine Di Iorio, Planning Manager Date
obi Yl I�.i. -bo 5010" L A v'c. S ca, ptv)� rl AV/ sr&r
Public Works Department
Steve Speer, Senior Engineer Date
Building and Safety Department .
Mark Harold, Building and Safety Department Manager Date
Health Department
Date
Fire Department
Date
Schools Fees`Paid .•
Date
veA
Attn. Kim Fincher
KSL Development
56140 PGA Blvd.
La Quinta, CA 92253
Subject:
Submitall Includes:
Dear Kim:
VANDORPE CHOU ASSOCIATES, INC.
CONSULTING ENGINEERS
295 N. Rampart Street, Suite A
Orange, CA 92868
Tel: (714) 978-9780 Fax (714) 978-9926
The Heritage Collection
Roof Truss Drawings for Pool Bldg.
Since 1979:
Facility Planners
Code Consultants
Structural Engineers
Fire Protection Engineers
April 22, 1998
Two sets of roof truss shop drawings by Spates Fabricators for the subject project were
received by our office on 4/22/98. The drawings, dated 3/13/98, have been reviewed for general
conformance to the design concept of the project structural plans, and no exception has been
taken to their use. The fabrication processes, techniques. of construction, dimensions, and
quantities are not a part of this review. Since the shop drawings were reviewed only for general
conformance with the structural plans, unless variations from the structural plans have been
clearly indicated, we may not have listed them. Our review of these drawings does not relieve
the truss supplier and the framing contractor from complying with the structural plans.
If you have any questions, please call me at (714) 978 - 9780.
Very truly yours,
VANDORPE CHOU ASSOCIATES:
AI
W-AAbe Blunda
Attachments: none
F:\JobFiles\095\BBG 1130\truss2. wpd
MDS CQNSUL TING
STATION
ELEVATION
PLANNERS • ENGINEERS • SURVEYORS
CUT
y
17320 Redhill Avenue, Suite 350
(714) 251-8821
Irvine, CA 92714
FAX 251-0516
d
TRACT '` +�4��' JOB NO: Lf/
C'i ' `�
NOTE: THREE (3) CONSECUTIVE POINTS ON THE SAME RATE OF GRADE
AND ON THE SAME LINE MUST BE USED IN COMMON TO ESTABLISH LISTED
STAKES'FOR /7(4 /
GRADES WHERE NO OTHER MATCHING IMPROVEMENTS ARE PRESENT. IN
;f
41
CASES WHERE STAKED IMPROVEMENTS ARE TO MATCH EXISTING PAVING
STREET fir"' y /� +. /�'
-� �r..(
OR OTHER SURFACES, CONTRACTOR SHALL VERIFY MATCH LINES AFTER
FORMS ARE IN PLACE, AND IMMEDIATELY REPORT ANY EXCESSIVE
STAKED BY DATE
/'�
DEVIATIONS FROM THE INTENDED GRADES TO THIS OFFICE. THIS OFFICE
z`.
CANNOT BE HELD RESPONSIBLE FOR ANY ERROR IN THE FINISHED GRADE
CHECKED BY DATE
WHEN THESE GUIDELINES ARE NOT STRICTLY ADHERED TO.
OFFSET TO 9/ /% CUT OR FILL TO •�`�' GRADE
ti�
B.M. OR T.B.M. �.1 -. o .%. SHEET OF
STATION
ELEVATION
GRADE
CUT
FILL
REMARKS
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-
. COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY_ -
DEPARTMENT OF ENVIRONMENTAL HEALTH
POOL AND SPA PLAN CORRECTION
DISTRICT # PLAN #-
DATE
PROJECT NAME P 6 8 PROJECT LOCATION jv\
OWNERICONTRACTOR
The plans are now approve . d subject to the conditions listed below:
0 rK Va-Q_Ar If- C� tO'w rA"( 0(aul
A
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m (x C ),'A t -0� \r -el- 0,- 4tGAnn (P"_ 4 e -dl ir�11V 's \4s4e 1\N
CONSTRUCTION INSPECT11UNS: Contact tfte-Plan Checker for pre-gunite and pre -plaster inspections at least three (3) working days in advance.
m P,
A FINAL INSPECTION MUST be made upon co et tiod of all work including fencing, safety equipment and signs. APPROVAL to operiti shall
not be granted until the facility -ha , AL INSPECTION, and "APPLICATION TO OPERATE" ha's,been completed and PERMIT fees
have been paid.
REQUEST FOR FINAL INSPECTION H70�13 •eMDE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE
PLAN CHECK BY 7v�
Phone 14OZ2 d,
I acknowledge the corrections noted herein and as indic' edthe pI s and agree to incorporate them during construction:
Signature'.
Company
Date
DOWSAN-181(RW192)
Y -APPLICANT P -BLDG. DEFT.
M