0312-012 (SFD)' LICENSED CONTRACTOR DECLARATION
U I herehy affirm under penalty of perjury that I am licensed under provisions of
H EFia�ter 9 (commencing with Section 7000) of Division 3 of the Business and
(p'�a
ill W J Professionals Code, and my License is in full force and effect.
License # Lic. Class : Exp. Date-,
i
Z rr� Date Signature of Contractor
O �
co
r— F -o OWNER -BUILDER DECLARATION
ww� 1� ,.
� W I hereby affirm under penalty of perjury that'l Am exempt from the Contractor's,\
U) License Law for the following reason:
Z_ ( ) 1, as owner of the property, 6F rhy 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 cdnstruct the project (Sec. 7044, Business & Professionals
CY)Code).
LO () I am exempt under Section B&P.C. for this reason
C\1
Date Signature of Owner
rn
QWORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm ^under penalty of perjury one of the following declarations:
, p (.) 1 have and will maintain a certificate of consent to self, insure for workers'
X LLI LL compensation, as provided for by Section 3700 of the Labor Code, for the
J Q performance of the work for which this permit is issued.
Q CJ ( ) I have and will -,maintain workers' compensation insurance, as required by
Q . Section 3700 of the Lbor Code, for the performance of the work for Which this
1 0)H permit is issued. My workers' compensation insurance carrier & policy no. are:
It z Carrier '.Policy -No.
ob EXEMPT
Q (This section need not be completed if the permit valuation is for,$100.00 or less).
J (It )` I certify that in the,pe'rformance 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 ifll.should become
subject,to.the workers' compensation provisions 'of�Section, 3700 of the Labor
Code„I,shall forthwith comply with those provisions. V
Date , / ?... ore) -:f.,?Applicant
®- Warning: Failure to secure Work'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 here6y'made to -the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. t
r 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 rrepresentatives of this City'to enter upon
the above-mentioned property for inspection! purposes. I'
Signature (Owner/Agent) !-�f .Y'� e� /1V i� Date 12 - //J
BUILDING PERMIT PERMIT#
0312-01.1 -
DATE VALUATION LOT TRACT
$31911.517,70 36 :i9i�1�ml.,
JOB SITE
ADDRESS—j��.E1
APN
OWNER
CONTRACTOR /DESIGNER / EN INEER
�EI=-.0;Y f�A1� k1:E18R., rr.�
�i�1Lcc;;��a�r7>vr�+a�a arc
81-07`1 C'IIA14'TIC1'sl?.F..�
78.070 CAD17, _
!tea QUNTA CA. , 9225'3
L11. QV.�d' :['A CA 92:15:
(760)564-4,842 CS.L4 323 ,
USE OF PERMIT
SF. IA:)*r 36, .PLug1.4 2H rev.; .PE:Y.M.1T .DO93 NOT INCLUDE tix,.t•XX
'
- �I�i:�1.,5,�1;L�t7J.� �i',t1.4��t Ciltl�•F'01's�§.'Y,?�.F'}�.{"aU.taG�� : ,, ,. � _ --
�I
MISTOM Ctil�3ai:R'43G`!I<a14 �i,`�!ih,CO 5p'
f'CaitQ:.l- PATIO 11,053AD SF
GARAGE6Q ARPORT i1 .OD :3I7
P.MIT 1721 SUMMARY
W14STIlUCT1 14 PEE '101.000.418.000 sl,ma
MANI t;P:9ECK FEE 101-.0001-43.0-318
MECKi1.IMAI, FEE 101-000.421.000 �i�,i►tt
Is'•I..WTI'Me. FEE 101-000-420-000 $2152M
s'r¢talaD MOTION DUE- RESID 101-0010-241-100
€ `„int"NC FSI; 101.000.423•'000 $15,00
DZVELOPER MPACT M19
-
ART 04 PUBLIC PLACG3 - l UME 270.0()0.445.000 S443,779
aw4A AT Y CHECK
$6,393.4
IM5 PRE -PAID P03.9
'0
DISC 10'2003
=_
CITY OF LA QIUINTA
" FINANCE DEPT.
RECEIPT
DATE `
/J • �'?
BY
t�!
DATE FI ED
s, --
INSPECTOR / -
r
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.K to Wrap �� /
-
Exhaust Exhaust Fans
F.A.U.
Fra /
Compressor
nsulation
Vents
-FtrepTa—ce P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath z�
qry.wall-Int th d
Final
Final 3 'POOLS
-SPAS
BLOCKWALL 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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service low—
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
CL
CITY OF LA ,QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNER_c`/ KoPt= P,4Rjgc�RS TLLG BUILDER 9AtltJ'ZIA Ca�tis�d�a,�l /AL
This form shall be Dost d on the job with the Building Inspection Card at all times in a cQnspic rnr,s Dlac . Only persons appearing on this list or their employees are authorized to work
on this -job. 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 cam I t d b I'
Trade / l aasilication
:. Ctintractar•'
V ee
... Staie Contractor's Licerise
y app leant. On Flle Is not an acceptable response.
..
Woikers Com ensatiori Insurance ' City Business License
Company Name
Classification
(e.g. A. ii, C -el
License Number
Ixxxxxx)
Exp. Date
(xxlxxlxx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp_ Date
(xx/xx/xxl'
License Number
(xxxxl
Exp. pate
lxx/xxlxx)
EARTHWORK (C=121
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Jun 04 04 09:38a John Read 760-777-8789
THE S.UIIMMI T A T PGA WEST
TRANSMITTAL SHEET i
To: Kay - City of La Building From:' KJ -1y Koger. -
Fax: 777-7011. Pages:'l
Phone: Date: 6/4/04
Re: License,Changes CC:
File
❑ URGENT ❑ FOR REVIEW
f ❑ PI:.EASF CUMI.II;NT
❑ PLEASE REPLY ❑
PLE'ASE RF.,CYCLF
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 -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 #°04027018
4 81-040 Shinnecock Hills
Permit # 0402-019
-- - 5 81-050 Shinnecock Hills- - -
Permit`# 0402-020'-
402-020 J6
681-060 Shinnecock Hills'
Permit # 0402-021
7 81-070 Shinnecock Hills
Permit # 0402-022
35 57-870 Troon Way,
Permit #0312-011
6— .7;900 Troon Way
Pe m t #031201
37 57-930 Troon Way `
Permit #0312-013
...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'.
7 49-045 Calle Flora
Permit # 0306-481
- -- 81-076 Cbantideer Dive * Ia Quinta, CA 92251 * 766-_71-3497 " 7(U-777-8789 fax
JON TANDY
78-194 ELENBROOK CT
PALM DESERT, CA 92211
OFFICE 760.772.7192
SPECIAL INSPECTION WEEKLY REPORT FAX 760.772.7193
PAGER 760.776.3338
TYPE OF INSPECTION PERFORMED
DATE
SHOP WELDING
16 -Jan -04,
PHYSICAL ADDRESS
PERMIT NUMBER
5.7900XROON-EAJ-QUINTA —''
JOB NAME T6A,
TYPE OF STRUCTURE
LOT 36 @ THE tRADITtONS
SFD
ARCHITECT
ENGINEER
GENERAL CONTRACTOR
SUBCONTRACTOR
SOUTHER HILLS DEVELOPMENT
PALM SPRINGS WELDING
WELDING. INFORMATION
PROCESS G-..M.A.W. - E71T-9
WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER '
JOE ORT GA JOHN BY'ERLY - #875 .
I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED - w • 4 ; 1 1�� 1)
WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I �l INSPUTORS SI URE
HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS,,-
SPECIFICATIONS
LANS,"SPECIFICATIONS & APPLICABLE BUILDING LAWS. ' , . ICC 1111,326—
INSPECTORS
111,326_INSPECTORS CERTIFICATION AGENCY AND NUMBER
C. C..
4
ti
• e
IV,
STRUCTURAL STEEL SHOP WELDING FABRICATION REPORT
Start Date: f , I P. 2'oY Finish Date: I 16 , 200 L(
Fabricated atfkL,'l �fitN�S 0�i.g6' Job Name: (,oT �� ��o. � 1
FABRICATORS
PIECE#
,rsvrrw�—
ASTM #
va>=ixarasu'r✓.rc
SIZE
)L iia
SINGLE
PASS
WELDING
.scomrra.-e
�cc.
MULTIPLE"
PASS
WELDING PENETRATION
im �vrm
COMPLETE
JOINT
WELDING
�vi�.vX�c's'
NON
DESTRUCTIVE
TESTING
DATE
xv,,aroar
REMARKS
.ss:�'.auPb�a""crc-ertsrssocvrrarro
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PQ -r .
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P Soo
to R
RSW
10 �-S Otq
hCG
19 Pf
(FSO
&Ul-
• All materials conform to approved plans, specifications, AISC, and AWS DIA unless noted.
0 ACC in single pass, multi pass, or CJP columns represents acceptable welding and no corrective work required.
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I drtifi&ate#"i�i,�issue'dpursuantf"to;..tiCi ie=,kequire Mlents' of Sedtioni,109 of.,the`-Cali o dildin
'45
C6de; cbrlifyinj. 4that;?�at 'the time, of4issifi§nce, 1,zthis stAichWe 'compliance with v th&
me,
kzprovisions ofcAhe Buildings Code 'and,� the-vifio"usI.
orcinances •;of'the'City `regulating building,.
w4-
13
consttuctioi�candl& use ImA
l ot _4�
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,BUILD N G'A b D R E S S: 7 9 0 0 T R 0 0 N WkY_,'-_-
14" 44
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T lBuildih ermit ci..
ZUse classification:', SINGLEFAMILY. DWELLING g -P' --.0312-012'
4
Occ"up-a-'n-i.-y,uroup.-.R3��,.,,'. -Y-Type of Cohstrudtio'n"lVNt%:_Y = Land Use Zone RL
tg,
eUiz
YR t b P -1Z -;3 r ST.
Owner bf.136ildi4f WRISKOPF'PARTNER& LLC4,
W 'SZIP: LA-QUINTe,.-reiQ2253' �4
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tv t
"
%�l An By: `GARY. HARTMAN.Al�,
2
01A
Date.7: FEBRUARY ,'200
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