9709-023 (AC)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 #.L-ic=CIass Exp. Date
113�j2 3 �''y 3/3i/99
/3/)/Y7Signature of Contractorate
ice/ J
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.
I have and will maintain workers' compensation insurance, as required by
(y
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:
CarrierW�"� `1.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 I should become
Zb' t to the workers' compensation provisions of-Sebtion 3700 of the Labor
de, IsVfortwith comply wit ,those provisions.te: r/Applicant,. °:` C
Warning: Failure to secure Workers' Compensation coverage is urilawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void, if
work is not commenced within 180 days from date of issuance of. such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and he'r"eby-authorize representatives of this City to enter upon
the'above-mentioned property'for inspection-.pu_rposes.
Signature (Owner/Agent) 1" t' VV mate
BUILDING PERMIT PERMIT# CONTROL#
CM �233-� 5860'
DATE I[�� #,191 VALUATION T17.4;�o� � LOT TRACT
JOB SITE �,t.;_
ADDRESS t�1,3_ i
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
�'-N a LAND11
lir 1. t 't 'f i,. Ji`MINT ;:'tlUP
T,A CA '9Ax53
LA Q1€N".a"A, dlA 9_53
USE OF PERMIT
POOL tru—J�DING S. RIESTR,,Oc�lki-
,w..�k»Ax n•ew
s
A AJ, k. 1 t.nl1 0 Y �': ±t. pill.`+ u!,V�l .fir
t.
•ia;i�a ai$:e`.s.tlii:+ur i+l;7.i,+r '6;i; �;'•s .h.i 4.�i9..p
i�;'_�ii:a9i
PLAIN CREC-K FUJI 101,-W0s ,;9 18—
f,°Ci?, so i,?vc-, ' oN T;'F;r f o
geee�•�-
pp R { �I*ny+P' � P a p5+ }•kf1/� {Fi}� ./x ` yyl !•:1
ASC,.A'a'✓ t d.'�A6..�.�a•: �: +. ils"•i3tdV"'�lAf��•i��J .. J1.7.�.d�.+
'
L LtJl�tb�fi�i01 ! �, to a titi } $75.00
�
31`!tf 1.0Li�iE3°iION-�t�:Sf1.) lot -WO -241,40 11.76
}'®
215- M_ -r ;tt4i s'J g t2
t:
W o
`I QI'All! Pf,RN41 VIi3U% 041.1+, NO
wl3 �€:.moi
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
sio4 A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel LVA
Combustion Air
Roof Deck 7
Exhaust Fans
O.K to Wrap 101411,41 4 A
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath 1111171
OQ
Final
Final 1 --,.k/ -
POOLS - SPAS
BLOCKWALL APPROVALS
Ste4
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines O /
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
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) '
Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext. 235
Project Name:
Owner's Name:
KSL LANDMI
This Bog For District Ilse Only
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Date: September 30, 1997
Phone No. 760-771-3642
Address: 56-185 JACK NICKLAUS BLVD., LA QUINTA, CA 92253
Project Description: RESTROOM ADDITION
APN• 761 550 027 Tract #:
Type of Development: Residential
Lot #:
Commercial XX Industrial
Total Square Feet of Building Area: 324 Sq . Ft.
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 a gn on behalf of the owner/developer.
Dated: �7 0 Z IQ Signature:
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
53080/65995 65970 Approval
Number of Sq./Ft. 324
Amount per Sq/Ft. $ .30
Amount Collected $
Agreement Existing. Not subject to fee
prior to 1/1/87 requirement.
Note:
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Administrator in Charge In
Certificate issued by: Marcela Valdez Signature:
Facilities Clerk
NOTICE: Section 6602O of rte Govenunet Code enacted as Assmubly B1 3081, set forth as Chapter 549, Statutes of die State ofCalifornia, 'a,1996 eff e Jan 1, 1997, requires Out Otis school d rovide a written notice to
die project applicant at One tune of payinet of school fees, udligation payment or other exactions. This notice is to advise you Out any protest hi regard to such muounts or One validity thereofin accordance with Section 66D2O
of the Govenutett Code mid other applicable law, commences with such payment or perfonumhce of any otter requuanet as described in Section 60020 of Ohe Govenunett Code. Additionally, Otis notice advises Gnat the
protest diereof must occur within 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-Com.Sam. (REV. 1/97)
DEVELOPER FEES PAID
AREA:
QQ
AMOUNT: $
RCPTA
cK. H:
CASH:
INITIALS:
DATE:
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Date: September 30, 1997
Phone No. 760-771-3642
Address: 56-185 JACK NICKLAUS BLVD., LA QUINTA, CA 92253
Project Description: RESTROOM ADDITION
APN• 761 550 027 Tract #:
Type of Development: Residential
Lot #:
Commercial XX Industrial
Total Square Feet of Building Area: 324 Sq . Ft.
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 a gn on behalf of the owner/developer.
Dated: �7 0 Z IQ Signature:
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
53080/65995 65970 Approval
Number of Sq./Ft. 324
Amount per Sq/Ft. $ .30
Amount Collected $
Agreement Existing. Not subject to fee
prior to 1/1/87 requirement.
Note:
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Administrator in Charge In
Certificate issued by: Marcela Valdez Signature:
Facilities Clerk
NOTICE: Section 6602O of rte Govenunet Code enacted as Assmubly B1 3081, set forth as Chapter 549, Statutes of die State ofCalifornia, 'a,1996 eff e Jan 1, 1997, requires Out Otis school d rovide a written notice to
die project applicant at One tune of payinet of school fees, udligation payment or other exactions. This notice is to advise you Out any protest hi regard to such muounts or One validity thereofin accordance with Section 66D2O
of the Govenutett Code mid other applicable law, commences with such payment or perfonumhce of any otter requuanet as described in Section 60020 of Ohe Govenunett Code. Additionally, Otis notice advises Gnat the
protest diereof must occur within 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-Com.Sam. (REV. 1/97)
ARCHITECTS
August 29, 1997
Mr. Mark Harold
Building & Safety Manager
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re: Pool Building Previously Used
for 54-372 Southern Hills
Dear Mr. Harold:
KSL has the permission of BBG Architects to reuse the pool building originally
developed for 54-372 Southern Hills for a new building to be located at 56-185 Jack
Nicklaus Boulevard.
If you have any questions regarding the reuse of these plans, please, don't hesitate to call
me.
Sincerely,
BBG ARCHITECTS
Pamela McPhee
Director Business Operations, CFO
cc: KSL/Paul Dooley
A BERKUS DESIGN STUDIO
26 CORPORATE PARK / IRVINE CALIFORNIA 92606 / 714/261-1795 / FAX 161-5515 / E-MAIL: BBGARCH@FLASH.NET
t
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH -
POOL AND SPA PLAN CORRECTION
ov.
DISTRICT # �—� t PLAN #- S�1700 t<
DATE 9 /� /� %
PROJECT NAME p G () �S' l r PROJECT LOCATION
OWNERICONTRACTOR
The plans are now approved subject to the conditions'listed below:
S�roo Nf-I Usf , e+ 4-14 ,Q �_q a tS
S
.— cam.^ k ram C' c i i � � �'�f 4 Cf- A to c r � i G rh ,i r k Ct S V) r-koyd/ �' oCPc
I e
t �GGC nJ l �t c� tin ti. in o � } l
? Qv n. co S C G�(a Q zs (,n I s - y Cly c�-�- C cs� V
( /Ju
CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre-gunite and pre -plaster inspections at least three (3) working days in advance.
A FINAL INSPECTION MUST be made upon completion of all work including fencing, safety equipment and signs. APPROVAL to operate shall
not be granted until the facility has passed the FINAL INSPECTION,.and "APPLICATION TO OPERATE" has been completed and PERMIT fees
have been paid. i
REQUEST FOR FINAL INSPECTION S OULD BE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
PLAN CHECK BY �, t /� ` Phone
x
f
t (
I acknowledge the corrections noted herein and as indicat d Zn /epla s nd agree to incorporate them during construction:
Signature
C / f
Company
Date t
,
UUH-5AN-1U1(Hev1/sz) vv-ut-NUt — r-APPLILANT — P -BLDG. DEPT.