0009-073 (CSST)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
Date "L dD Signature of Contractor(•I'kJ�
A t .
OWNER -BUILDER DECLARATION
I. hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) •l, 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),.
( L)� 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. foF this reason .. f
Date A/70/00 Signature of Owner -; �C�
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( )'
[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 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
Code, I shall forthwith comply with those provisions.
Date: 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
the above-mentioned property for inspe.�ctiioon.purposses.
Signature (Owner/Agent] j`�j�- "� 7Gr'1d� Date -1 �
-P BUILDING PERMIT PERMIT#
DATE VALUATION LOT OW -073 TRACT
JOB SITE
APN
ADDRESS ♦ ,e9 (+�q�pyd�N� tt1,
767-330-052
OWNER
CONTRACTOR/DESIGNER/ENGINEER
m. :�'cr xnokis wG
XU1.1:M]ERTUSORTS INC
49.499 EIW.i :owpa TX1
49.4499 MEWHOWER DR
I'AQU T:A CA 92253
LAQ ngTA, CA, 92253
CRL*.
USE OF PERMIT
crabo"MCm
391 SQ. Irf. COMFORT SUT1011
PORC1.11PATIO 210,09 SP
0M?A0VCA,RPORT (SF) 71tib3.60
iii'. UKrED COW Inas' C:€�t��i'�:�J�:�®�i
3�t�i�Bfi4D .
)MMUXf FEE N8y MA Ri k
a°t`r'tJS'1'43:'UC�'t0� P'�E • � 9] -O�U�i �a0(3o �42a.40
PLAX CHECK REE 101»000-439-:318 $144.30
MWHANt(_* L FEE 101-000421-000
11..LFX,I` RICAL.. J%Z f01-f3iK4420-000 $63.92
PIAL MBINO VU. 101.000-419«000 911#150
5TR4"aNO MOTION "1p • COMM 100-000-241-000 $1,20
GRAD1110 FEE 101-000-423-000 111.00
,A11?T 1A1 P•UBILIC &'I.Pt. ES - COMP 7011.-060-255.000
U-33 TIRE -PAW M73
S0100
DCEC 2 G 2i
..I� -I Ai
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4Underground
Ducts
Forms & Footings
j> b
Ducts
Slab Grade
Return Air
SteelCombustion
Air
Roof Deck
/ 0osev
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
d
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
�01 m
Final
Final _ ��/ _�,
BLOCKWALL APPROVALS
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Q
Approval to Cover
/ Q
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPRO AL
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final '
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
fj L
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Condult
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:
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_ Ci of La` Uinta '
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- Building 8L Safety Division •f
. I t P.O.. Box 1564' . .
.
Permii #: "''
+
78-495 Calle Tampico -
r,I'�'
La Quinta; CA 92253 i
gt� `' ` ` '
Building Permit Application and Tracking Sheet '
Project Address
Owner's Name:. � `; " ..1
i
A. P. Number: t n % / t ✓•- , Address: '
g l -83a'� b��a .
Legal Description: '
,ST, Zi � •
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Contractor: I„
elephone:'
41�
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Address:
Project Description: -, " • , •
Cin.ST, Zip:
1/x/1 � d^
Telephone: P
•
State Lic. #.: •
City Lic. #: .� _�• -
Arch., Emu- Designer: •
' - ' '
Address:
39 5 - -
(0�0 G�w� 1 i !0 3 . loo
City. ST. Zip:
'� 10 2 13 30 _ �PaTle t� . 27g �j •d O
Telephone:
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Construction Type: e.
Occupancy'- YP
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Li
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Project o ect a (circle one : �N w
e
ryp ( ) Add'n Alter Repair emo
1.
Name of Contact Person:�aZ4
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)s
. Ft.: 1
# Stories:
# Units:
Telephone •# of Contact Person:
P
. - Iz
- "� /�
�S . Estimated Value of Project: I(9 4 tP ,fob
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07%03/01 14:41 FAX 760+771+41.32 CONST KSL RESORT 1 101
KSL Desert Resorts, Inc.
49-499 Eisenhower Drive Phone: 760-777-4$55
La Quina, CA 92253 Fax_ 760-771-4132
' 1
July 3, 2001
City of La Quinta
78-495 Calle Tampico
PO Box 1504
La Quinta, CA 92253
Attu: Greg Butler
Project: The Greg Norman Course Project #: $P3160 E
Re: Comfort Station $1.°$3O TBuR.o+��e. Job #:
Dear Mr. Butler
The bldg. permit (0009 - 073) for the. comfort station was issued December 20, 2000 and we do
not plan to start construction until October`2001. I would appreciate if you would.. issue an
extension for this permit. please let me know if you require'fi.rrther information. j
Thanks for your consideration.
Sincerely,
I 1 , of LA��INTA
BUILDING & SAFETY DEPT.
Andrea Merrill -Mock ' AP P R ®V E®
Project Manager oo 17 ;40%i;
fot �stos 'r►'tW
DATE.
1 o5 O\ BY
CC:
End. 6
tti
r
07-03-01 15:31
RECEIVED FROM:760+7'i1+4132 P.01
0",
Community Development
_Public Works Department
File Building Department
Ch�vo LaQuinta
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 applicant for resolution of conditions
preventing or dela in approval.
Project: - 81-830 TIBURON D (COMFORT STATION)
Applicant Contact: KSL DESERT RESORTS INC
ANDREA MOCK 760 777-4855
Application / Circulation Date: 12/12/0
Community Development Department Date
Christine Di Iorio, Planning Manager Date
Public Works Department
�at
eve Speer, Senior En ineer e
Building and Safety Department
Greg Butler, Building and Safety Department Manager Date
Health Department
Date
.Fire Department
Date
Schools Fees Paid ,
Community Development
Public Works Department
File Building Department
CityLa o uin to
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 applicant for resolution of conditions
preventing or delaying approval.
Project: 81-830 TIBURON DRIVE (COMFORT STATION)
Applicant Contact: KSL DESERT RESORTS INC
ANDREA MOCK 760 777-4855
Application / Circulation Date: rDate
Communi evelopment Department eazChristine i Iorio, Planning Manager
Public Works Department
Steve Speer, Senior Engineer Date
Building and Safety Department
Greg Butler, Building and Safety Department Manager Date
Health Department
Date
Fire Department
Date
Schools Fees Paid
(Certificate0'f Occupancy
City of La Quinta -
Building and Safety Department J�°FMo,Mt°`'�
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 following:
BUILDING ADDRESS: 81-830 TIBURON DRIVE
Use Classification: COMMERCIAL COMFORT STATION Bldg. Permit No,: 0009-073
Occupancy Group: B Type of Construction: VN land Use Zone: RL/GC
Owner of Building: KSL DESERT RESORTS INC Address: 49-499 EISENHOWER DR.
City: LA QUINTA, CA., 92253
By: BILL GORDON
Date: 2/26/02
Building Official
POST IN A CONSPICUOUS PLACE
0
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/ RIM: 457.26✓
IN: 451.84
-OUT: 451.74
EXIST. 1
T V.C.P. SEWER r
PER C•V.W.D. DWG. N0. -
25453 -
Id
Larry Benson
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
4.
Indian Wells
4.
Indio
.;.
Lake Elsinore
.;.
La Quinta
4.
Moreno Valley
Palm Desert
Perris
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable, .
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
- In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900 • Fax (909) 940-6910
September 20, 2000>
To: KSC Desert Resorts, Inc.
49-499 Eisenhower Dr
La Quinta; CA 92253
Re: Structural Building Plan Review
SDP 99-653 / Comfort Station
Fire Department personnel have completed a review of the plans you submitted for the above
referenced project. Please be advised the following conditions apply as a part of the conditions for the
issuance of a: building permit.
1) -nFire Department approval is based upon the 1997 UBC requirements for Group B occupancies. It is
prohibited to use, process or store any materials in the occupancy that would classify it as a Group
"H" occupancy per Sec. 307 of the 1997 UBC.
2) Install portable fire extinguisher(s) per NFPA, Pamphlet #10, but not less than 2A10BC in rating.
Contact certified extinguisher company for proper placement of equipment.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
Applicantrinstaller shall be responsible to contact the Fire Department to schedule inspections.
Requests for inspections are to be made at least 24 hours in advance and may be arranged by calling
(760) 863-8886.
All questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKI -
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
H:IPE2\WPDATAILAQUINTANPROJECTSIBLDG PC\SDP99.653-ComfortStation.doc
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 20° Fl., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
Coachella Valley Uv`id School District
P.O. Box 847, Tht:. mal, CA 92274
(760) 399-5137, Ext. 235
e '
This Box For Uistnct Use Only
DEVELOPER FEES PAID
AREA: - -
AMOUNT: " RCPT r.
CK N: CASH:
INITIALS: DATE:
Y
CERTIFICATE OF COMPLIANCE, .
(California Education Code 17620) -
r
Project Name: ?Date: December 12, 2000
Owner's Name: KSL Desert Resorts, Inc'. Phone No. (760) 777-4855
Project Address: 81-830 Tiburon Drive. PGA West, La Quinta, CA 92253
Project Description: Comfort Station
APN: 767'330 052 Tract•#: of #'s:
Type of Development: ,Residential Commercial. XXX Industrial
Total Square Feet of Building Area: 39
Certification of Applicant/Owners; The person signjng certifies that the above information is correct and makes this statement
under penalty of perjury acid further represents ghat he%she is authorized t6 sign on behalf of the owner/developer.,
"Dated: Signature•,
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SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project' Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Note:
Number of Sq -Ft- 391
Amount per Sq.Ft. $ +`
Amount Collected $ 129.03
Building Permit Application Completed: Yes/No
By: .Foch "Tut" Pensis. Assistant SmRerintendent Administrative Services
Administrator in Charge
r ,
Certificate issued by: Marcela .Valdez Signature:
• Facilities Department '
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEE AND STATEMENT OF FEES�
'^ Section 66020 of the Government Code asserted by Assembly BU13081, effective January 1, 1997, requires that this District pro1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees" h of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice.shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof; commences with the, payment of the fees or performance of
any other requirements as described in section 66020 of the Government code., Additionally, the amount of the fen Imposed is as herein set forth, whether
payable at this time or in whole or in pan prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days startsoo the date hereof. This "
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School
. District. and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
Rev. 09/27/99