9704-073 (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
59`7073 "a 701 i98
Date Signature of Contractor
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).
( ) 1, 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.
-V) 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.
S111XIIE POND
(This section need not be completed if the permit valuation is for $100.00.6r 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 prov ions of Section,3700 of. the. Labor
ode, I sh II forthwith comply with tl�ose�visions.
Date: Applicant
w�
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 f%o.rinspection pu%`poses.
Signature (Owner/Agent) `"% - / Date -
BUILDINGPERMIT PERMIT" °°NTR°`#
a fr 54.30
DATE P VALUATION
� � e�hy`��� LOT: TRACT 27�3J?
JOB SITIE
ADDRESS
�1� 1 :
APN 761-490-036
�7I^J i �3i&eti l� i
OWNER
CONTRACTOR / DESIGNER / ENGINEER
•-
I MID E.01NO
ray ttu r�a�c W; tr t� Uri Vr E,O r Nrf
BEI:d,i1AJDA. Uf..JNES CA 92201
(760)34'0735 CAL# 1960
USE OF PERMIT
SIT)
8.0.)-'t'I<ti)1411T b0k'S I' YVI IN ..UDE ik moi±. WAI.Lzl, Ck F'S:JO.L
.;t} ':►taltil �.:'siid,�:i`i�lit,"i'iUly ', 3fi.€i() �i�
KiKti7'Itp'i 00 61101) Stl
fAPLA4sCARiOW' 823.00 ST'
EST:d,li.iAT7110 C T O ,31li . %i
VCHMfr.iVV% (1ip•j-li'iM1-I<.I•d•`Ir'
.`< r2d it'Rt}i `1'ii :N' A iks lCi,1-tlUti-4 i F.±_000
�`'t ,�•?d �,tig>r,"fw'.!'l�' 1ilf -Ct()t}-�f��.�.12� 5f i�rf+,,';i
38
t�ti l:i lr�Pdil;i19y 1 I.L �t}i ()(ilir Z.i li l) $06.00
rl(,t,INMIfaQFEI lEli,t}f)C1:4 , A)W ... $221.,75
`iMANe": MOTION 1116 32.1:10 .101 W1 44,1,-wo $303.85
(`i.T:Ai:,% NO i+ia, iiti-iiflti- I - 1ii aU.(bf3
iiii"CtnS`i'.RIICQ".iVRHPER ZX5- (?-44!= 2 asr,t?�j3,t��f
ART i:tdfA;ilZI'Jr-fy1,AC"i,`)• 1033'i'V I -00( -2S5 -OW `Gfui6.:t�
811134M.00:0 CONStRUCTIONAND.PT.ANC-11:t:K
S10zt57,�-O
t.t � :k't:EPAID FEE
41,000,00
TOTAL Vf?Fi1VgIT i+.CE,of NOW
ti9g157,59
RECEIPT
�..
DATEj
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
7 .
F.A.U.
Framing
7
Compressor
Insulation
- 8
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_ G e -'
Dgwall - Int. Lath
Final
Final
-
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPR VALS
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) - !-r- ,
ELECTRICAL APPROVAL
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) lj '
I
Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(619) 399-5137, Ext. 235
This Boa For District Ilse Only
DEVELOPER FEES PAID
AREA:
AMOUNT: RCPTA:
CIG M CASH:
INITIALS: DATE:
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: Date: July 2, 1997
Owner's Name: David Kong Phone No. 345-7755
Address: 57-328 Interlachen, La Quinta, CA 92253
Project Description: Single family i ng
APN: 761-480-036-9 Tract #:
Type of Development: Residential XX Commercial,
Total Square Feet of Building Area:
Lot #:
4,290 Sq.Ft.
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this
statementement under penalty of perjury and further represents tliat 1 ie is tQr1Azed to sign on behalf of the owner/developer.
Dated:T�T Sign
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.
Number of Sq./Ft.
Amount per Sq/Ft.
Amount Collected
A.290
$ 1.84
$ 7,893-60
Note:
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcela Valdez Signature:
NOTICE: Section 66020 of tie Covenunent Code enacted as Asseubly Bit 3081, set forth as Chapter 540, Statutes of Ilse State of California, 1996 effective Jan 1, 1007, require tat this school district pr" a written notice to
the project applicant at die tune of payment of school fees, nutigation payment or other exactions. This notice is to advise you tat any protest ut regard to such amounts or tie validity thereof ut accordance with Section 66020
of tie t1ovenuneut Code and older applicable law, conunences with such payment or perfonuance of any other requirement as described ut Section 60020 of tie uovenunent Code. Additionally, Otis notice advise Oat Ote
protest thereof must occur widtun 90 calendar days thereafter.
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/industrial projects.
Dev. Fees Disk: Misc\Cert-ComSam (REV. 1/47)
11_Yi:i„1,11 :1, :!1 1,.., id! Ij1J "ILI JIt1 1.
,�dtiF• ii;!
PG'rA WEST~
June 11, 1997
David Kong
57-388 Interlachen
La Quinta CA 92253
Re: Architectural Application/Custom Resident
Lot 1 - Interlachen, La Quinta CA 92253
Dear Mr. Kong:
PGA WEST 11 RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(619) 776-5100 PAX(619)776-5111
I am pleased to report that the Architectural Committee has approved your plans submitted for a
custom residence at the above -referenced address, under the following conditions:
1. Owner Kong agrees to deed portion of property on other side of northern side yard
property line wall, which is bordered by the Smith residence.
2. Neighbor Smith pays for all engineering costs in conjunction with #1 above.
3. HOA agrees to waive all architectural fees, including the $10,000 performance bond.
4. Need clarification on new tower design submitted by architect - will the wrought
iron gates have wood panel inserts, as do three other custom homes on street? What will
be the color of the wrought iron? Are windows above gates in tower decorative, or
functional?
5. California pepper trees should be substituted for jacaranda trees in front yard as
shown on landscape plan. There are no other streetside jacaranda trees on Interlachen.
As noted, your plans are approved pending receipt of the recorded Grant deed on the side yard
property. Please have your General Contractor contact my office with any questions.
Sincerely,
FGA WEST 11 RESIDENTIAL ASSOCIATION
For the Architectural Conunittee
By
JOHN HANDEL, ASSOCIATION MANAGE.
cc: Don Troy, Architcctural Chair, Board of Directors
`i W
RECORDING REQUD �Y
AND WHEN RECORDED 'TO:
RANCHO CAPISTRANO DEVELOPMENT,
P. 0. Box 980
La Quinta; CA 92253
-VIrfJ -//SLe
Above This Line for 1V6St>iRWsN%Only
GRANT DEED
THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $236.50
[ X ] computed on full value of property conveyed; or
l` 1� computed on full value less value of liens or encumbrances remaining at time of sale;
unincorporated area; [ X ] City of LA OUINTA ; and
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
DAVID C. KONG, a Married Man
hereby GRANT(S) to RANCHO CAPISTRANO DEVELOPMENT, CORP:; a
California corporation
the following described property In the City of LA QUINTA; County of RIVERSIDE State of California;
That portion Lot 1 of Tract 27332, in the City of LA QUINTA, County of RIVERSIDE, as per map recorded in Book
239, Page(s)46 through 49 of maps, in the Office of the County Recorder of said County, also being Parcel 1 of waived
parcel map 27757.
DAVID C. KONG
By
Yiu Wah Kong, as his attorney in fact
Document. Date: February 6. 1997
STATE OF CALIFORNIA )SS
COUNTY OF )
On before me,
personally appeared
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(i) Is/are subscribed to the within instrument
and acknowledged to me that he/she/they executed the same In his/her/their authoiized capacity(les) and that by his/her/their signature(s) on the instrument
the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature
Mail Tax Statements to: SAME AS ABOVE or Address Noted Below
JUN -26 -97 -WED 9:09 ESI FME INC FAX NO. 7142618506
'ESI/FOIE, Inc.
STRUCTURAL ENGINEERS & CONSULTANTS
May 19th, 1997.
RANCHO CAPISTRANO DEVELOPMENT
79-687 Country Club or. 0201
Bermuda Dunes, California 92201
ATTN: Mr. Tracy Dale
RE: Roof Truss Calculations and Layouts on "Kong Residence" for RANCHO
CAPISTRANO DEVELOPMENT -CO. (ESI/FME 397-7964)
Dear Tracy:
P. 01
We have reviewed the calculations and layouts by BROWN & HONEYCUTT TRUSS SYSTEMS,
INC., they appear to comply with the requirements of our calculations and the structural
pians with a few recommendations.
The review of theseArawings does not relieve the contractor from compliance
With the drawings and specifications. This check is only for review of general
conformance with the design concept of the project and general compliance
with the Information given in the contract documents. The contractor is
responsible for confirming and correlating all quantities and dimensions,
selecting fabrication process and techniques of construction, coordinating his
worts with that of other trades, and performing his work in a safe and satisfactory
manner.
Thank you for your attention to this matter, please do not hesitate to contact us if
we can be of further assistance to you on this project..
Slhcerely,
E811FME,Inc.
4
1921 E. CARNEGIE AVE., UNIT 3-J, SANTA ANA, CA 92705 - Ph. ( 714) 261 - 1811 / FAX (714)261-8500
Certificate of Occupancy
City of La Quinta
Building and Safety Department
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:
57-328 INTERLACHEN
Use Classification: SFD.
Occupancy Group: R 3 Type of Construction:
Owner of Building: DAVID KONG
Building Official
Bldg. Permit No.: 9704-073
VN Land Use Zone: RL
Address: RR4 SIMCOE .
City: ONTARIO, CN N3Y 4K3
By: STEVE TRAXEL
Date: 5-15-98
POST IN A CONSPICUOUS PLACE
e
®F [-h NJINTA
tgE I
JON TANDY
3580 Condalia Ave.
�N-= Yucca Valley, CA 92284
�SPECIAL INSPECTION SERVICE, (760) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETESTRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT O OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCA.UOhn y � � `i_ t / A Qu t,.,, -TA -REPORT
G
SEQUENCE NO.
Pj PERMIT N0.
TY.QF�RUyu1RE /�
DAV Of WEEK
MATE IAL SC RJ PTION ARCHITECT
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL SUB
DATE CONTRACTOR CONTRACTOR
06 LJ Q-� ��� Cy ooJ
J '
(De -GI S ( 0 e-- Tcs c -i i�
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
IHEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
^?ED. I,HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
7-'r..:.IEICAT!ONS, AND APPLICABLE SECTIONS OF THE
.-- IzAWS --
SIGNATURE OF REGISTERED I PECTOR
TZA
DATEdftftOF REPORT REGISTER NIIMRFR
If
IF
floe
i■iiiiiiiii�i�
MEN
SO
CIE
MINES
MOMiiii�i�ie�MINES
MISSION
*Materials and weldments conform to plans and specifications and RISC, and AWS D1.1
Shipping Mark Special Deputy Insp.
905 SHEL .