9701-018 (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
511773? B '"'"`` 12/*11 h9g
r
Date �'� LISignature of Contractor { W �- w
- r
OWNER -BUILDER DECLARATION t1'
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).
( ) 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
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,LR ICS# VNIt, Co.
WC161SM96505
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
,/Date: %.17 AApplicant 1,.01. 1
--
(I OF
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. c
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
c nstruction, and hereby authorize representatives of this City to enter upon
e above-mentioned propergfor inspection purposes.
Signature (Owner/Agent),Datel _ 4/ `1 j
v
BUILDING PERMIT PERMIT# CONTROL#
�r1 4 8 76,
DATE ?>b-7/17 VALUATION SZ41,&1110 ' LOT 2�� TRACT 340 1
JOB SITE
ADDRESS :+6440 JACK NICKLAUS B.OULI- FARO
APN ►
701-550.OJI
OWNER
CONTRACTOR / DESIGNER / ENGINEER
'%,SII AMD H
IKSL DEVELOPMENT CORP.
,
56•1/I0 VG)k BLVD.
A0ULx, VAPLD
LA QU1N"1'A CIA, 42253
LA QUIWA CA ?21253
(760t771-3642 CKH
USE OF PERMIT
ISF0
> PqA WEST -1415,,UTAGE PLAN 2AR
CUSTOM. CION51Mt1:MON 2872.01) Wit:
P(:)k<(„kUl�Ji'CCi.3 .s6.1.Exi tii:
40rAHA0WCAit!' )KT 677.093F
E.i•1.1AIA'ITED CORE OF CONSTRUC" 101
1'� �tt111'1' iF i;,1, 5li)if`x twlA1K't'
CC N.TrRIA7,1'!C>N 'h E L 1!!1 -{tom -4 i i-iiCfi) Sx.l;l.:iC)
PI.ANamr 3�fE3 1f31-fH1fJ-#39-31£ 341,0
,4YCCIIANICA , t3 iS, 101 -000 -.421 -ON $85. J
lJ,1:{ i'!tl Al.1 ks1 10i={k -420-G,00 317#,
#'LUhtf3lhi�} k i i:.�k to] -ow -40-000 $179.25
'r7t()tf4�r+�K i�,liit� N) 101-000.241-0 $11.18
i;12.AIANQ 101.0004'23-000 32f+. o
lNFt7/L`r1'C�f"1`tJft4: '.�.2:�-Gt1{}��3-3114 'x5,3:�.4fs
_
A#2'r IN PU111,W' PLACU: (RIiS) 701-000-255400
I(�flii�,t"CaNSTtt fC '1C)NAi+i1?- PLAN 04F
$,225.?t
LESS PRE -PAID FM
$0DO
1AAR 2 7 1997 '
cpl
LA
RECEIPT
DATE
BY �• `•"�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
ifi
Underground Ducts
Forms & Footings
1A I
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
7
F.A.U.
Framing (,f,
Compressor
Insulation
G
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath15
G
s7
Final
Final
/ o
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 APPROVALS
Gas Test
Electric Final
Waste Lines
Tj
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
I
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
U,Ttj Notice (Perm)
2.4,s VANDORPE CHOU ASSOCIATES, INC. Since 1979:-
CONSULTING
979:"CONSULTING ENGINEERS Plan Checking
VCA 295 N. Rampart Street, Suite A Building Inspection
Orange, CA 92868 Code Administration
Tel: (714) 978-9780 Fax (714) 978-9926 UBC, UFC, Title 24, ADA
May 21, 1997
Attn.: Kim Fincher
KSL
56140 PGA Blvd.
La.Quinta, CA 92253
Subject: Heritage @ PGA West
La Quinta, CA
Lot 25, Plan 3B
(Lot 26, Plan 2
Lot 29, Plan 1
Dear Kim,
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: QR()FESS/O
UNG. �lF
�4�
UJ M No. S 003518 s
Robert Chou, S.E. UJ o o ni
* d Exp. 3-31-00 c Z
X-
BH:jw T'9UCT�PP� a�Q'ff
c: Paul Dooley FOF CA1-��%
f:\jobfiles\095\BBG 1130\Field 12.wpd
4
c/7), o" f
_.l (),,
RFC, JON TANDY
0/1vu 'XidV6. 3580 Condalia Ave.
w°Yd iota Valley, CA 92284
(619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE 'AiriTRUCT. STEEL ASSEMBLY ❑ c�`
❑ POST TENSIONED CONCRETE ❑ ASPHALT �B'>1THERJh()P WE�ayl�
❑ REINFORCED MASONRY ❑ FIRE PROOFING J
JOB LOCATION 4� J 7 //� J��
\V/ K A (lilt/ TfCI
REPORT SEQUENCE N0.
TYPE OF STRUCTURE 6I D
PERMIT NO.
D4L7-'?7
DAY OF WEEK
MATERIAL J�IESCRIPTION �-���
x[71 3(/(J
ARCHITECT
INSPECTOR
AS
-TTAA'N✓�
HRS. CHARGED
—%v/J2 45— '7..L T-1/
ENGINEER
ASSISTANTS If
HRS. CHARGED
INSPECTION GENERAL SUB
DATE CONTRACTOR . . S • CONTRACTOR S• t/{ %/ `v
4-747
of Aqs c
)01—ATE, E—G T/ JA �-
EA -775. J'�X / X Cv�S•
Ecls� 1/E %Es iv gas
COPY SENT TO CLIEN ❑
TINUED ON NEXT PAGE ❑
PAC,E 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.
>V:t;77q
v- v
SI NATUR . OF REGISTEREDPECTO
,06'a cl
TE OF R ORT REGISTER NUMBER
I
Certificate of Occupancy
City of La' Qui
nta
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 bui/ding construction or use. For the following:
BUILDING ADDRESS: 56-240 JACK NICKLAUS BLVD
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building:. KSL LAND II
Building Official
Bldg. Permit No.: 9701-018
VN Land Use Zone: RL
Address: 56-140 PGA BLVD
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 10/14/97
POST IN A CONSPICUOUS PLACE