9606-162 (SFD)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
579175:
Datef i)�—� Soignature of Contractor, - yr
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). r
( ) I am exempt under Section , B&P.CIfor'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 she yLab�or Code, for the performance of the3woo vffor•which this
permit is Issuer any -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 1 should become
subject to the workers' compensation provispns of Section•3700 f the Labor
Pode, I shall forthwith comply with tho`sepr visions.
Date:: _2 t-17�, f2/Applicant � 'e—
Warning:
j1Warning: Failure to secure Workers' Compensation coverage i� s ,unl`a 3ful 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 abovnformation is
correct. I agree to comply with all City, -and State laws relating to the building
construction, and hereby authorize representatives of�this City 10 enter upon
the above-mentioned property for inspectionpurposes.• -
---,r'/ �` Fla
Signature. (Owner/Agent) _ fDate
BUILDING PERMIT
PERMIT #
CONTROL #
3789
DATE 7/2906 VALUATION S-385,450.90 LOT
TRACT
JOB SITE 57-444 INTUtAtOC "
APN 769-48-0-0
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
l ig 1C.ONG
RAMA-10 C;A -II.MANO DEVELOPM1,11,
,
79687 COUNTRY RY C:I;:i B
DR ,1{20.1
.
BERMUDA DUNES
CA 97201
(G19)345-7755
f: 8L.If 1969
USE OF PERMIT
l.il+lCiLH.PAA 11,k L7Wi L,IING
4611. Tht10tAVENUE
`NRWPQRT A A04 (°A, 92i%fi
Kgq)41Ul3AHT IJOES NOT IWI.IUD13, 01,0C'ia WALL CfR PC"►M.
0
G"�'�°;J��I''/�1C�)(Cf��,Ll.
S1,6y40.50
{I�I.�t}f)
`'yy�ld*, CHECK
%xL.AN'��'.t 3i:'+CK IT- 317 .101* :00-43:-318
IT-3137
a32i338!16
FER
rv4rCKAt*CA!, PF,iti
S156,00'
C�
F. d\f�lyl 101000.420.000
$�i7.90
CI rn
Sn7JSk��7.�M �`� X• N W ' e '� .. tol.io*419-000
1;t�i iii'1'Ff 3�l i is :iti"s ali7 101-000.1411-000
X38.55
c�
GRAJAN , M6 101-010-M-000
�: ". iAGr3
Q� _ i
4FRAMM17MA1s ME- 225-W64,411-342.
$t►.OiJ0,00
–7 i
ART Its FU.LUC PLACES . C ESID 01.000-255-000
MTMA.UC'ONS',1 )IC;'TKON AND MAN Cf
$10,413,64
t;SC�YEEsslID F
-$250.::4
-TOTAL, 1,11KRAHT FKA IDUEy'Now
$10,11.63.64...
RECEIPTDATE
BY
DATE FINALED
INSPECTOR
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
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate lines
Party Wall Firewall
Exterior lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVA S
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS .
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out ZVI bEquipment
Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral AJWA
Pool Cover
Sewer Connection
Encapsulation .
Gas Piping
Gas Test
Appliances
Final
Final
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)
COMMENTS:
;
'
COACHELLA VALLEY UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name:
Project Address: 57-444 Interlachen, La•" Quinta, Ca 92253
Project Owner's Name: Ed Kong Phone No.:
Project Description: Single Family Dwelling.
Building Type (Check one): ( Residential xx (Include No. of Dwellings)
Tract No.: Lot No.:
(If tract, attach Schedule "A" of all lots by tract, square footage for each lot and total.)
Assessor's Parcel No.: 769 480 036
(If Schedule "A" is used show Assessor's Parcel No. for each lot if one exists or Assessor's Parcel No. for parcels before subdivided.)
Total square feet of Building Area: 4,624 Square Feet
Certification of Applicant/Owners. The person signing certifies that the above information is correct and makes
this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the
owner/developer. C
Dated: Signature:
rV 6
City/County Certification:
(Signature) Optional
(Title)
*RRRRRRRR***RRR*RRRR**RRRRRRRRRRRRR***RRRRRR*RRRRRRRRRRRRR********RRRRRRRRRR****RRRRRR*R*R*R
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE):
Gov. Code Gov. Code Project Agreement Existing Not subject to fee
53080/65995 65970 - Approval prior to 1/1/87 requirement.
Note:
Total Number of Sq./Ft. 4,624
Amount per Sq/Ft. $ 1.84
Amount Collected $' 8 , 508. ,
School District Official,:, Title: Asst. Suuerintendent, Administrative Serv.
Foch 'Tut" Penns
Date: July 29, 1996
Phone: (619) 399-5137, Eat. 235
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/mdustrial projects.
r JM- 3-96 WED 1025 AM MONARCH GROUP
FAX NO, 619 360 4160
July 2, 1996 PGA WEST II RESIDENTIAL ASSOCIATION, INC,
P.O, Box 1282 Le Qulnta, CA 92253
Mr. David Kong
Re: Custom Home - Interlachen
PGA West
Dear Mr. Kong:
I am pleased to report that your submittal of working drawings for the above -referenced
Custom Residence in PGA West II Residential Association has been approved by the
Board of Directors and Architectural Committee, with the following conditions:
1. Stucco color unacceptable - too light - piease resubmit sample no lighter than .other
Custom Homes on Interlachen.
2. Roof file single color unacceptable - please resubmit samples of multi -colored tiles.
3. Stucco surface must be "rough", not smooth as submitted,,
4. No Morala plants allowed in landscaping.
S. All structural specifications must be in compliance with all applicable City codes and
the PGA West II Architectural Guidelines for New and Custom Hones.
Please have yo& contractor Grant Normbeak contact my office at (619) 360.4161 with
any questions....I look forward to the resubmittal of the above items, which must be done
prior to commencement of constriction of your new home.
Your cooperation in these matters is greatly appreciated
Sincerely,
. t
PGA WEST 11 MS1DENTIAL ASSOCIATION'
John H. Handel
Associ
... anon A.41:izger
cc: Don Troy, Architectural Committee Chaim, an
Board of Directors
Grant 14ornbeak, Rancho Capistrano Development
'.Xnon3tch\usefs iohn'pgares3'Jcon;. da%id cusvmn honic 7.2.96A3.
® VANDORPE CHOU ASSOCIATES, INC.
��� CONSUL TING ENGINEERS
295 N. Rampart Street, Suite A
- Orange, CA 92668 '
Tel: (714) 978-9780 Fax: (714) 978-9926
City of La Quinta
Building and Safety Department
Subject: Plan check 49606-162
Kong Res.
Rancho Capistrano Development
Attention: Plan Checker
RESPONSE TO PLAN CHECK CORRECTIONS:
Since 1979:
Facility Planners
Code Consultants
Structural Engineers
Fire Protection Engineers
July 15, 1996
The truss shop drawings by Spates Fabricators have been reviewed by our office and found to be
in general compliance with the design I concept.
If you have. any questions, please contact Mike Burica at my office.
VANDORPE CHOU.ASSOCIATES, INC.
Ut
Robert Chou, SE P� �C���
co �4 g �Z
U0
No.
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