9710-006 (RPL)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 fulIforcea effect.
License # Lic. ClExp. Date
''C53 ftf/1198
Date; }0.0Signature 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).
( ) 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:
CarrierPolicy No.
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(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,,andjagree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with t'ho;ef`iqXrovislons./�
Date: V Y;�� Applicant
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 al�City, and State laws relating to the building
construction, and hereby authori7e r6oresentatives of this City to enter upon
the above-mentioned propecrtyy for inspection purposes.
Signature (Owner/Agent),.,k / f • _J/ Date
BUILDING -PERMIT PERMIT# CONTROL#„ -fir'
DATE 1.016197 VALUATION SVf3 fift ' LOT TRACT
JOB SITE %440 JACK N idW` 1,A fS APN
ADDRESS
OWNER CONTRACTOR/DESIGNER/ENGINEER
r .1AL[V0'isa+"1,' oPOK0.r S 14 PAS
74- 7:13 JON[ 'ti'6.L'+tv`f:, VA
1,A QJ1WTA CA W25 fyA.i jird -(A 92260
USE OF PERMIT
POOL AND)4C)R
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PLUMBA NG P ER — POOL 10140)-419-000
RECEIPT
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ESS
DATE BY
DATE FINALED
-to 7J.,If, �;4,_
INSPECTOR
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$407.35
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INSPECTOR
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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
0. 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 APPROVALS
Sted6
POOLS - SPAS
Set Backs
Electric Bond
IVI 017
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
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
- r
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:
V
To
Fax #:
Tv �vt �o a✓G- —
FAX TRANSMISSION
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
78-495 Calle Tampico/PO Box 1504
La Quinta, CA 92253
7,60-777-7125
Fax: 760-777-7155
Robert Warren
818-341-2104
Date: 11/6/97; 4:55 P.M.
Pages: 3; including cover sheet
From: Wally Nesbit, Associate Planner
Subject: Information for 56-240 Jack Nicklaus @ PGA West
" COMMENTS / INSTRUCTIONS:
In regards to your request on the above subject earlier today, please be advised of the
following additional information items:
1. - It is unclear 'which community panel number applies to this area. Panel
060709-00108 generally applies to this area and the index shows that it is in
a Zone X. However, the area is technically a part of Panel number 060245-
2270A, which relates to unincorporated area. I would reference #060709-
00108, which was effective 8/.19/91.
2. Also attached is a copy of the assessor's parcel map to show the property,
along with other information.
Should you need anything else, you may reach me by voice mail at 760-777-7069.
IF YOU DO NOT RECEIVE ALL PAGES, PLEASE CALL .760-777-7125
Q
= M E T R O SCAN PROPERTY PROFILE=
Riverside (CA)
****************************************************************************************
* <<< OWNERSHIP INFORMATION >>>
*
*
* Parcel Number :761 550 031 S: T:
R: Q:
* Ref Parcel # :000 000 000 Pos Interest:
* Owner Name :Ksl Hotel Land
* CoOwner
* Site Address :56240 Jack Nicklaus Blvd La Quinta
92253
* Mail Address :56140 P a Blvd La
g Quinta Ca 92253
* Telephone :Owner: Tenant:
* <<< SALES AND LOAN.INFORMATION >>>
* Transferred Loan Amount
* Document # Lender
* Sale Price Loan Type
* _ Deed Type Interest Rate
* % Owned Vesting Type
* .<<< ASSESSMENT AND TAX INFORMATION
>>>
*
*
* Land :$24,408 Exempt Type
* Structure Exempt Amount
* Other Tax.Rate Area
:20-025
* Total :.$24,408 Taxes
* % Improved
* <<< PROPERTY DESCRIPTION >>>
* Map Grid
* Census :Tract: Block:
* Land Use :R07 Vacant,Residential
* Legal
* Sub/Plat :Tr 28340-1
* Book :259 Page:44
*
*
* <<< PROPERTY CHARACTERISTICS >>>
*
*
* Bedrooms Stories YearBuilt;
AgPreserve
* BathFull :, Units MiscImprv:No
* Bath3Qtr Bldg SgFt: Street.
ADDITIONAL
* BathHalf Gar SgFt-: Waterfrnt:
* Fireplce :No 'Gar Type : Elect Svc:
RmAddtns :No
* Cntrl Ht :No Lot Acres: Gas Svc
RmAddSF
* CntrlA/C :No Lot SgFt WaterSrce:
AddGarType
* Pool :No Roof Type: SewerType:
'OthrPkng
*
****************************************************************************************
The Information Provided Is Deemed Reliable, But Is Not Guaranteed.
'URPOSES ONLY. NO LIABILITY
A SHOWN. ASSESSOR'S PARCEL
BUILDING SITE ORDINANCES-.
�.s
POR AW 21 T . 6S . , R . 7E 769
CITY OF LA OU I NTA 73
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48 MB 259/44-47 TRACT MAP N0. 28340-1
Aug 1996