0312-013 (SFD)LICENSED CONTRACTOR DECLARATION
Phereb;t affirm under penalty -of perjury that I am licensed under provisions of
1.2.�,?pter J (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
783403 B1 C10 mGn `4 J n"I1.4
Date' -_L11
ate' f C. ` ti' - e 'Signature of Contractor-'—�/
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I m 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 exempbunder 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 YV,,W'T . Policy No.
(This. section need not be completed if the permit valuation is for $100.00 or less).
(I`�) 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
CoSJe, I shall forthwith comply with thpose/provvisions.
Date: r1 -. a `1- %Applicant1s ��
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 inspection purpodesl.
ignature (Owner/Agent) Date "!o'%1.
BUILDING PERMIT' PERMIT JI
DATE VALUATION LOT �}o�.�i'�g ► TRACT
JOB SITE
ADDRESS 57.9 IROON NVA.Y
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
R'AT01MA(20HI MIC 10111;t' C
83fi071 C k tai' C;T,1.�Cit
7€-070 C.'.AT2 V .
1A QUInVA CA 92252
LA QL1 W -TA Ch 9112-53
(MAO)5e-x4>4832 MA 3237
USE OF PERMIT
MOLE FAMLY MVI -LING
SII) - LOI{ S7, PL&N 5, PERJAIT DOES NOT INCLUDE IILOCK WALLS,
P004 q1'?A,-Ok OR.IVIR ki'AY APPROACH
CUSTOM CONSTR!XTiON Vt}9.00 V
37OIZt~IY/l>t TIO MON V
G.A.RA.MUC:ARFORT 856.00 SI
PEMUT T :R 9UMAU Y
CONSTRUCTION FEE 1101-0,00-418,,600 $1,482.59
PLAN C:lik= rfm 101.000-139-318 $1,ab2..ai,
14 ICHMIC,A1. FRE 101.000.471-000 $169,00
ELFK:`f IUC;AL PEE 101-000.420-000 $267.54
PLUMUM0 FER 101.000.41 q-000 $200,25
STI2.OHO MOTION ME - R0.01D 101-000.2.4 2 -WO UP.74
ORADTHO OKE 101-000171223-000 $11.4100
AIT W PUl3UC PLAMS NNE -210-000-X145-000 WIN
YA
.., -,�f,.
.
y,-�`a[a �,�p.� yy� Amp �-�c�tr,��
Y-+ ...w •. 4,+'i �� �', ';.7'.,.IA.O..4'� T. W.�7.0 .C.1.�•ai"3 �.�.c7.f�.:..d:.
D 1'�is33PRL!:��PAIIa: ERS
q• q a�
.y�,��7ui: E.�7
�0,0i1
DEC 10 200�3�T IXTUM VVESDUE'Row
CI OF LA MANCE DEPT QuiNTA
RECEIPT
DATEr
BY
DATE 9NAYED
INSPECT ,
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
7
Exhaust Fans
O.K. to Wrap
_
v
F.A.U.
Framing
p �L-
Compressor
Insulation
2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - IM. Lath
Final
Final
t,
POOLS - SPAS
BLOCKWAL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
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
COMMENTS:
Final Z
Utility Notice (Gas)
ELECTRICAL APPROVALS _
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)
' Jun 04 04 09:38a John Read 760-777-8789 p.l
I �.
THE S.UMAII T A T PGA 'WE'S T
TRANSMITTAL SHEET
To: Kay — City of La Quinta Building From K;11v Koper ;
J
Fax: 777.7011 Pages: ' 1
Phone: Date: '6/4/04
Re: License -Changes CC: Fiie
❑ URGENT ❑ FOR REVIEW ❑ PLEASU CO M, M1:NT
❑ PLEASE REPLY ❑ PLEASE RF,CYC1,1;
Please find the following permit numbers that are to be changed from Kahuilla
Construction over to Southern Hills Development: Inc.. Thank you for your help
in this matter and if you have any furtherquestions, pleas 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.HillsPermit # 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
35- 57-870 Troon Way-011Permit #0312
.36 57-900 Troon Way Permit #0312-012
'S7= Permit #0312=0133
38 57-960 Troon Way. Permit #0312-014
39 57-990 Troon Way Permit #0312-015
The Tradition
113 53-900 Del. Gato , „ Permit #.0310-184,
The Enclave ti
7 49-045 Calle Flora
Permit # 0306-481
81-070 Chantidcer Drive * La Quinti, CA 92253 *760-771-3497 700-7.77-8789 fax
v
(n
O
N
W
I
I
O
(D
r
C
-C
0
r7
:�.:
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JO$ ADDRESS PERMIT NUMBER OWNERe(c"/SKariz PARr,JcRS TC•LG BUILDER ,9AJ,1fZ4A•
This form shall be nosted nn thegob with the Building Insoectlon Card at all times in a cQnspicuous place. Only persons appearing on this list or their employees are authorized to work
on this -fob- 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
Contractor `•:
State Contractor's License ' .
Woikers Cam ensatiori Insurance
City Business License
Company Name
Classification
(e.g. A. B, C-81
License Number
(xxxxxx)
Exp. Date
(xxlxxlxx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Data
Ixx/xx/xxl
License Number
(xxxxl
Exp. Data
lxx/xx/xx)
EARTHWORK(C-121.;..
/9.F(�t2�8i l{/Aar%SCv�ih71
C (i
61 �
-LI„Q
g•?=,F_jJp
aa9513 cel
INL)4
'9".497
3-�•� ..
CONCRETE (C-8).,;`:.'.. [-'iZA�Gd t�.JSf JG: rcH1 (rSG O'$
�y��$Cv2� 7--5i- CF,L�tJ-FP-t'��Oi�
G
�i�l�{Zfi(��� a 3 I �� . p o38�y
—
I
FRAMING (C -5f;' ;'
��it(G6hSS�R:I�OnJ CC,
Sj C/o
771P/9D
/�G
o-/G-of�,l+laco9r�y i%�
caoGz�
7-x7.-pc�
STRUCT:'CTFFI
Co`�g�C�
-7 31
V',4LP'.i.gA (fJSdad%dE
i5� -�f
/Uy
Iv/t&q,
o
MASONRY 1C-29)`'"::"" SfiQOR IKRSdJ(l C- 29
o,4-1-2-3 irigs. t•{li /O O&IzI4
3-22 61/
iIII PLUMBING (C=36)
aQ ft(cLf{iFA� lLi3L
C. 3 C;P
.199119
10/34kal5az
' a j 1,4,10 mwi-X
f-
401 !4z
r LATH; PLASTER (C 351,'<
MAfZ A RIZ{,(AL
.d
Di �►Jy
5785 0
y / o
o�Sy/
n -?1-03
DRYWALL.IC 91 ;^ :::.: F NIA r(JA DeZVyVAtLZa
41%
7
c -2o
3$271a 3
/� c1/
fF>a1t►v
/S•129a�-a
o31a7.
/o ?7U`l
ELEGTRICA4(C-1ol<x;
E(EeTare
C./D
71/817!
F±OOFIN.O:IC=39► .'<F ,r'<'' El-(EIZR�Qll IpiG,
G 39
77c y7/p
4% .��2
G9CPl5/
/2-28-d
SiIEET METAI`.iC 431:`" ..
9, r'9M l % LAQ$�
c:2�
382y1p 3
10/i
5;,. -tom yup
15.q ¢a
/! 0
-C! 3617
FLOORING,'IC•1�1:'
C �
• J LI
j�t)� �� CJ
GLAZING (C-171;-:`:;';>';'"
Gv./rJ CI.JB /rlrQiza�f e�LRs�
a -r7
77a+soo �,
t3°ra� 64142
v�b -�QW�' f6
! r/d'i
•0223`7
7_12 dyl
iivsiiiaTroN fdi ► °. `: %.: t//Es R� /�15.�1�ar;a�l [',�-
791 �S� '-. 1- A4.Mi&W Al -(c 1AJ5.
A15F2.14,`i ctY36
c D'
SEWAGE DISP. (C-42 :`
vJ��nU° it y1T�F
.rarLCy-I y
PAINTING (C-331 :' '
G 1 I} I (` i fl(l r
I—
'1
- �c vt.d
1 ` ��
1 �.. t
1 '7U i 5
I i
/t ll��
10
-0 LA �1
;Ml�.- G. ��n� I •�. , L
�11_391
31G1 5 � c Lh
C%18jNETSfC81 ::
� Ila rne�S
6C'✓`-
c 7
I -5i
�r� ��v
i
FENCINO'IC-131:..SA3.(Z
MAS�rJfz�
�- 24
!�{p9m3 3i o V,LC.4dPVA !r.}SdRjjJea
LANDSCAPING IC -27) :.
I—.� (�Y-i� Sr.t
1 -
�-
y & 1
Z
5
-�i G - PI�I°cn i Fr1r2r,r-
X 9
�wr1o��_/23!297 -3
W I ^ 3�i�Ji IX
`I lac' �?
`r1/
I
3 2`i•t)1-(
D _ tc1
� i;4
(C•531 '� n 1 ;r f + ' '%+
_
.POOL
a ;