0312-011 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
16Ch pter 9 (commeAcing 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
70503 D1 C10HIC �� ���31104,
f,Dat'e .19 - /01 6 Signature of Contractor iii'!
A
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:
( ) 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 EXEMPTPolicy No.
(This. section need not be completed if the permit valuation is for $100.00 or less).
(
(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 provisio srof Section 3700 of the Labor
Code, I shall forthwith comply with those prov/islons.
Date' ! . Io - /5 ,Applicant I', -
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 represel tatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent). Date! % ' !6",-0_5
BUILDING PERMIT PERMITN
DATE . VALUATION LOT O,Sc^t)X.k TRACT
c/ • �.; �4 3 5 291147.1.
JOB SITE
APN
ADDRESS
5'X-f701200N MNY
761
OWNER
CONTRACTOR / DESIGNER / ENGINEER
W12- IC0111Y PART NERS, LSCC
KAHUR.LK C0X1 "TJkUC1110N WC
81-071 CJa aM.C1MR
78-0/0 CADIZ
t,\ Q ;1WfA CA 92253
LA. quFDTTA CA92253
C760)564-4632 C'I 411 Rig 47
USE OF PERMIT
104GLE.RAM:L.3t' D'4Td1 4.jimo
Stvf), 1,01'351 PLAN 8.:PERAMI"f I OESNOT 1NCt.UD& BEa° CK.1iJ.F9f.LS,
PW4 SPA OR T. 3RIVI'y�lAYA''P11.OAC1:I
CUSTOM CON TttUC710-N 4,869.00.0
Pf7I8.s RIPATIO OC96.00 V
!3AR.A(.1fiJC:4RP0R.:f 9.1.1.00 i9y
rnw= C1109' OF COr 610t1iTC'I~'1ON,
408,31M.50
NUAIM1LRY
CONSTRUCTION FEE 101-000.418.000 $1,72}.04
PLAN CHECK frEE 1011-000-4-39-319 s1, k a.39r
IU11aCH", ICAL FY F, 101.000.421.000 $149.50
VI.LO%TRIU-1< FEE 101-000-420-000 $246.64
PU)MBINO FEE 101-000-419.000 S2 x,73
STROAfa MaVION FEB -MID ID 101-000-2.41-000 $40.I13
GR.A.Y3FRO FFF. 1'111-000,42:3-000 $13.00
IJti:VE.1,Oi ETC IMPACT F= $2,rtltti.00
ART 1W PUBLIC FLACM - iti 911 ?70.000.445.OW 852036
ISUB-JW,AL CQ?y'T=TK,43,1CxN A1,FD PLAN C.E41::M
$602 047
LESO PRE -PAID W&W
Moo
OT IERS i�S DUE NOW
"DEC1
$6,7'�OA7'
a 2003
CITY OF LA QIIINTA
FINANCE DEPT.
RECEIPT
DATE
BY
DATE F)NALEJD
INSPECTOR /
r 11
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
o
Exhaust Fans
O.K. to Wrap
ZZ
F.A.U.
Framing
Compressor
Insulation
VO
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2z D
Drywall - Int. Lath
Final
Final
BLOCKWALL
APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Dain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVAL
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
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)
APPROVALS
COMMENTS:
Jun 04 04 09:38a John Read
760-77778789
S a
THE S.UMMI T A T P GA "WES T
TRANSMITTAL SHEET
To: Kay — City of LaQuints Building From: Kelly Koger
r -ax: 777-7011
Pages:'i
Phone:
Date: 6/ 4/04
Re: Ucense- Change
CC: ' . ' Fite
❑ URGENT ❑ FOR REVIEW ❑ PI.EASL1' COMiME.NT
❑ PLEASE REPLY
❑ PLE'ASE REC1'CI,I
Please find the following permit numbers that are to be changed from Kahuilla
Construction over to Southem Hills Development: Inc.. Thank you for your help
in this matter and if you have any further questions, please do not hesitate to
contact me.
The Summit at PGA West
1 .81-010'Shinnecock Hills
Permit # 0402-016
2 81-020 Shinnecock Hills
Permit # 0402-017
.3 81-030 Shinnecock Hills
Permit # 0402-018
4 81-040 Shinnecock Hills
Permit # 0402-019
5 81-050 Shinnecock Hills
Permit # 0402-020
6 81-060 Shinnecock Hills
Permit # 0402-021
7 81-070 Shinnecock Hills
Permit # 0402=022
3�5 57870 Troon Way.
Permit #031 1::7
.36 57-900 Troon Way
Permit #0312-012
37 57-9.30 Troon Way
Permit #0312-013
. 38 57-960 Troon Way.
Permit #03127014
39 57-990 Troon Way..
Permit #0312-015
The Tradition
113 53-900 Del Gato
Permit #.0310-184
The Enclave
7 49-045 Calle Flora
Permit #0306-481'
81-070 Chanticleer Drive * La Quinta, CA 92253 * 760-771-3497 " 760-777-8789 fax
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CITY OF LA QUINTA SU8-CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNERILLG BUILDER IiAj4d,L44 C'oJs etc io J J'S[<.
This form shall be Dosted on the iob with the Building Insnnrrion Cara at all limesa cQnspicuous place. Only persons appearing on this.list or their employees are authorized to work
on thls#ob. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File' is not an acceptable response.
..
Trade !Classification �: Coritreeto� •` Srwin Cn6e.n.-r..r. r t...::..
`.;:.:..,
Company Name
Classification
(e.g. A, B, C -al
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
fxx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-121 „
.:....
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L
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CONCRETE(C•81,.` ` FtZAAIC� �.JST'ZJGi�c,rl (rJc C-$
1o2�CF, L%c�-irenUo'r, U�iCR00�� ��3 I/c.p�• o38ly
—
FRAMING (C-51,.:.,.:.;
":::....
$ ' C/0
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s i;r1.�D
c SIG-cfi+F�woyrjy ; %�
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MASONRY (C-291':.".;. S,aIi02 MRSo,JR/ G- 29
3 22.611
P4l1MBING(C=36). .'
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SHEET METAL`,(C-03)>t`r.
X,:9rrStT LAQ$7/
3$2'`/03
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PAINTING. (C-33) ; ' ': :.
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LANDSCAPING (C-27) ..
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SAI'IVSH S, HAH P.E.
CONSULTING ENGINEER
3920 E. Coronado Street, Suite 203, ANAHEIM, CA 92807
. r:
PHONE: (714)632-1865 FAX: (714) 632-1314
>>
E-mail: satishsshah@earthlink.net
May 10, 2004
Southern Hills Development, Inc.
,
81-070 Chanticleer
La Quinta, CA 92253
Attention: Jim Avenell
Reference: Structural Observation
Summit at the PGA West
Lot 35, - Plan 3B
57-870 Troon Way, La Quinta, CA
Dear Jim:
On May 10, 2004 we made visual observation of the structure for the above referenced lot.
Framing and hardware locations appeared to be in substantial compliance with the approved
structural drawings.
Please contact our'ofiice.any time for questions regarding this.
HOAK & SHAH ASSOCIATES, Inc.
Satish Shah P.E.
C 56112 1 „ No. C 056112 '
.: Exp 310 ��t
J'�9 C1 it �?'
TYPE OF INSPECTION PERFORMED
r2
DATE
SHOP WELDING
19 -Jan -04
PHYSICAL ADDRESS
PERMIT NUMBER
_-57�$70TROOl�I'LAYG2U;INTA'`�-�
JON TAN by--'-,'
'✓- �-^
78-194 ELENBROOK CT.
•
PALM DESERT, CA 9221 1
ARCHITECT
OFFICE 760.772.7192
SPECIAL INSPECTION WEEKLY REPORT
FAX 760.772.7193
SOUTHER HILLS.DEVELOPMENT
PAGER 760.776.3338
f
-
TYPE OF INSPECTION PERFORMED
r2
DATE
SHOP WELDING
19 -Jan -04
PHYSICAL ADDRESS
PERMIT NUMBER
_-57�$70TROOl�I'LAYG2U;INTA'`�-�
JOB NAME""" "` ' '^+✓
TYPE OF STRUCTURE
LOT 35 e' c-roAr%1:9lGP1C
ARCHITECT
ENGINEER
GENERAL CONTRACTOR "
SUB CONTRACTOR ,
SOUTHER HILLS.DEVELOPMENT
PALM SPRINGS WELDING,
_DESCRIPTION OF WORK INSPECTED
1/ i 9 - OBSERVED SHOP WELDING OF 9 E.A: TS COLUMNS. ALL COLUMNS HAVE BASEPLATES,
BEAM BUCKET, AND NELSON STUD BOLTS, ALL WELDING APPEARS AS PER APPROVED PLANS.
WELDING INFORMATION
PROCESS G .M.A.W. - E71T-9
WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER
SALVADOR FLO RES EARTHSYSTEMS #616-36-6021',
{
I HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED
WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE
INSPECTOR'S SIGNATURE
FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS,
SPECIFICATIONS & APPLICABLE BUILDING LAWS. ICC 1111326 -
INSPECTORS
111326 -INSPECTORS CERTIFICATION AGENCY AND NUMBER
C.C.
S
f
-
r�
STRUCTURAL STEEL SHOP, WELDING FABRICATION REPORT'
Start Date: (, i (e 2.01>4 Finish Date: (� • 7-°° `i'
Fabricated at. 9FPJo� OCM4- ,lob Name: t,oT
FABRICATORS
PIECE #
j 3 r+
ASTM #
.(I
k 500
SIZE
dADi'OAliJfJ4%YDtI
10 x 5 x'Af
SINGLE
PASS
WELDING
fII.IYI/.MCTi%P,
MULTIPLE
PASS
WELDING
'COMPLETE
JOINT
PENATRATION
WELDING
.�,(Ap/•
NON
DESTRUCTIVE
TESTING
DATE
V..O/O�RiY�'9.V.C.Oa9Tq.79/AlG3i/t/Opls��"JC�OYO�i�JA'!+�OY�i1ClbT1
REMARKS
WCLAT 8 ucKer 5-nkoS
161
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be,
I `1 R
NS OD
i��� `/�i
N&C,
� L A
A50o
10,.. 5 S4
k&CI
�. 3 A
R -50o
0 j-,5
k6,
2.1 A .
(�- goo_
10 x S K °!'
_ ��G
2 -OR
k500
5x -5y, Ill
Nbe,
31*A
RC, -)60
10>c�x`!
kc,—,,
0 W
A-ccfio
10 x.5 I/q
ku,
• All materials conform to approved plans, specifications, AISC, and AWS D1.1 unless noted.
• 'ACC in single pass, multi pass, or UP columns represents acceptable welding and no corrective work required.
f,.