9701-017 (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.
Dense # Lic. Class Exp. Date
At
Y2, .�f `' i
Date { Signature of Contractor r l�lct_':'
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 solem
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 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.
() 1 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.
7.rU4:fCH,:rN110. co, t31tW;`i .31if1& t15
(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
s� bject to the workers' compensation -provisions of Section. 3700 of the Labor
Code, I shall fort1hwith comply with those�provisions.r
Date: r�.i /��Applicant
%�
Warning: Failure to secure Workers' Compensation coverage is unlawfMul 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
dnstruction, and hereby authorize representatives of this City to enter upon
Ahe above-mentioned propeJrtyyf,for inspection� purposes. �
Signature (Owner/Agent)`+
BUILDING�PERMIT PERMIT# CONTROL#
�
X701- ))1 4 8 5
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DATE . �a.7VALUATION 386,383.40 LOT �� TRACT xis,141-1JOB
SITE
ADDRESS6-.�9+,�.i`A�.:�iK-l�f.�°�:KUW8 H+�?iJit,[!,�`Ai O
APN 76.1^5}50-030
OWNER
CONTRACTOR / DESIGNER / ENGINEER
K&L
KSL DEVELOPMENT CORP.
-
56-140.EGA BLVD.
Sti140 k� .�i i3GU1. ;1/t1Etf�
,A, Q(AbMA CA. 92253
1,A. f UINTA. CA 92253
(760)171 w'1642C 1..1LIf
USE OF PERMIT
POA W'z's^.IT-.HYMC.TAGJ PLXN MR,
��s 9'+::f:.�-t �;��N,4� 1'Iztr�•tv'rt :�;:ssl s.ot, SC
'
' ,L71=1STt'l A.;e�Al.�..0 CXJ 1. 0.fy'+6,:-?JI�i.A'rl�.kaitl �. Y..t60!'+
f 0N,Ttrft{JP.:..ff0N FhV, 101-000418-000 $1,294.00
fl,AJ4C
MECHANICAB..r=: ", Z 101.000421-000
101-000-420-6W
ALCTl03100 iflt�Ot 1i -Op0 $ui�.
S'1'isQN0MOTION (£Cl^:S) 101,MI- 41-000.
c; AA0111'G 101-0i_t0423-000
XMf RASTUC"t'I IRE 225-000-443.342 66.00.00
ART 11`f PUAL1C P'I CES (RES) '701-000-255-M S445.96
Q4. ` N'✓.ii.J �F'r!a�VYw�Y ��.ASY'SSin L. :Y»f. Z/F�CI•i
$4��3��2,7
1
USS PR,.8,-PA D 1±h%S
BAR .2 ' 997 If rf f.AL 111: r� "Miff FFI R9 ,01JE NOW
$9,392,37
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
.
V+
SPECTION RECORD
Y
at
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab GradeJA
Return Air
Steel
Combustion Air
Roof Deck
S /
Exhaust Fans
S 7
F.A.U.
Framingp
• Compressor
Insu a io
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Q
Drywall - Int. Lath
10aw /ZP
Final
Final
t
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas '
4 14
as r
ppliances
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
lit�`,tice (Perm)
A
a
Certificate of Occupancy
City of L.a. 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: 56-190 JACK NICKLAUS BOULEVARD
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: KSL LAND II
Building Official
Bldg. Permit No.: 9701-017
Land Use Zone: RL
Address: 56-140 PGA BLVD
City: LA O.UINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 9/23/97
POST IN A CONSPICUOUS PLACE
C 7Y 4r L4 OUIN7A
R l 6 prCp ,JON TAN DY
BUILDING AWD S,4 3580 Condalia Ave.
Yucca Valley, CA 92284
(619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT _.7.9?HER1: 5/w��,�Ja(w,
❑ REINFORCED MASONRY ❑ FIRE PROOFING wwt���
JOB LOCATION6_190/,4� N /`aZ�vs
J
/ 14/��'AlTJ4
/
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
,5 FL)
PERMIT NO.
D!•AJi.E G
1
DAY OF WEEK
MAT IAL DESCRIPTIONARCHITECT
- �4- 5760J:
INSPECTOR
FAA
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL
DATE CONTRACTOR S
SUB
CONTRACTOR
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COPY SENT TO CLIEN
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE \
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE '
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
Wv`
SIG ACTURE F RE TEREDSETOR,C() 7)` /� ��r�'
DA OF RE RT REGISTER NUMBER /�J
VCA
Attn.: Kim Fincher
KSL
56140 PGA Blvd.
La Quinta, CA 92253
VANDORPE CHOU ASSOCIATES, INC.
CONSULTING ENGINEERS
295 N. Rampart Street, Suite A
Orange, CA 92868
Tel: (714) 97879780 Fax (714) 978-9926
Subject: Heritage @ PGA West
La Quinta, CA
Lot 25, Plan 3B
Lot 26, Plan 2
Lot 29, Plan 1
Dear Kim,
Since 1979:
Plan Checking
Building Inspection
Code Administration
UBC, UFC, Title 24, ADA
May 21, 1997
In accordance with your request we visited the jobsite on May 14, 1997 to perform a structural
job walk for the subject houses and found the structures to be in compliance with the plans,
calculations, and design concept.
If you have any questions, contact Benjamin Herbst of our office.
Very truly yours,
VANDORPE CHOU ASSOCIATES: QROFESS/O
i
Robert Chou, S.E.
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