9701-019 (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
1 pf
Date "' +` '� Signature of Contractor "t�{
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:
Carrier . Policy No.
MPUCH INS. f;0.
(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
gabject to the workers' compensation provisions of Section 3700 of the, Labor
/Code, I shall forthwith comply with those provisions: ..` .
Date: '"t 41 1 /-�'fAPPlicant •-----��- ,. .f/ 1�1 1 ra``'t "
r
I Warning:- ailu e'to secure Workers' Compensation coverage is unlawful �nd
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 d,
whose request and for whose benefit work is performed under or pursuant toi
any permit issued as a result of this applicaton agrees to, & shall,'indemnify.
p
& 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
ythi/above-mentioned property for inspection'purposes.
nature (Owner/Ageni)" �i h s - � te,7'? ��
BUILDINGPERMIT PERMIT# CONTROL#
_3/1-
DATE
7/� VALUATION LOT TRACT
JOB SITE
ADDRESS 7 �p : 1 �:�1, i� ���;lfl��.li! .>!illr✓;�.��tv >
APN 761^_r%%_03_Z
OWNER
CONTRACTOR / DESIGNER / ENGINEER
11%,
l,"L DEVELOPMENT CORP.
56-1 40 f'Gik 131, V0.
56140 PGA. BC3i.?`l,i 'IJA.CiD
LA, Q1 JINT.A (-A ►22.53
LA ±;iClffrA. CA SQ153
crill
USE OF PERMIT
ins A WSW - fL[•:AdT ,09 PLA14'KNk,
�+t,A,ta �,llf Gk�. f°fI' u.1s`f)Ut,;l3f.t 1^t<?IZ tV1.tJ1.'l1!"�t,,115;.ITL? ti{, �A�k 1't.l1iN
CUSTOM .0011 ;•�'tROC,T ION` 3,441.00 Sr
Ltrlf:Af3}JE lildE�a db'1" '00 SF
r �` lk t"�D �'fj *iii CONST Ttt'`HOIN
0�,NS7, RUr11ON FE'S 10.1-000-418-000 $1,244,Vt
PLAN N C-MICK MIL rd.64,23
MEC..1•3AMCAL VMES. 10t Baa -421.000
BLECMC.AL-.: ?`iS 101-000-420-000 189,C�(I
PI.,tl 113.f NO FF:1?5 101-W-40-600 S213.255
.
XfRONO M0110N (ij,4) 328.4+4
�MATXN ; . 101 -OW -4- 223-000 v0.00
INF*", Tflli.WO :2254WO.443�-342 $6,0000
llflX 1N . UBUC K A.C95 701-000-255-000- $46 5.9,6
KV TAL C,'ONSTR(JUI'IOIN ANI) Pt,-ANC.IfrCK
8,599.68
L WSS PRIE-MI) FEES
30.00.w. -
0.00...T0
7 AL PPi RYgOT N9E1'wA.DV F NJ 0' F
TOTAL
S8,s99.68 y'
ltl►�y� .`j rte. -
•BY
RECEIPT L
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
Return Air
Combustion Air
Roof Deck /
Exhaust Fans
O. K to
F.A.U.
Fra ing
Compressor
Insulation p-14
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
POOLS - SPAS
BLOCKWALL APPROVALd
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping 7
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection Ile
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)
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: 56-290 JACK NICKLAUS BLVD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9701-019
Occupancy Group: R-3 Type -of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND 11 Address: 56-140 PGA BLVD
Building Official
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 10/8/97
POST IN A CONSPICUOUS PLACE
REGISTERED INSPECTOR'S WEEKLY REPORT
�PlobJON TANDY
3580 Condalia Ave.
Yu'ec�alley, CA 92284
(619) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
�THE�Sj-)016ak �
{ ry
JOB LOCATIO
OC. `�
Ma- ' o JAS,
^ D�ii✓TA-
H
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
PERMIT NO.
A E?
'A4-7-q7
DAY OF WEEK
MATE Al- DES��tIPTION
JJ�r//JJJI 3 {{{/(((-JJJ
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/'7/
ARCHITECT
INSPECTOR
HRS. CHARGED
E- 7v/P
E— 7.�i-//
ENGINEER
ASSISTAAN,T�(S
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR � �.-
SUB
CONTRACTOR
1,,CiL, v/ L -sem
-�L7-47
6S6P-oCd 6i44
A ss R)E Id.
v F ASE
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COPY SENT TO CLIEN
NTINUED ON NEXT PAGE O
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.
GNATU OF REGISTERED SPECfj�,�
- 25
fT f E OF F&PORTI TER NUMBER
05/29/1997 09:04 714-978-9926 VCA ENGINEERS PAGE 02
®_ VANDORPE CHOU ASSOCIATES, INC. Since 1979:
CONSULTING ENGINEERS Plan Checking
_ 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, AOA
May 29, 1997
Attn.. Kim Fincher
KSL
56140 PGA Blvd.
La Quinta, CA 92253
Subject: Heritage @•PGA West
La Quinta, CA
Lot 27, Plan 3B
Dear Kim,
In accordance with your request we visited the jobsite on May 22, 1997 and May 29, 1997 to
perform structural job walks for the subject house and found the structure to be in compliance
with the plans, calculations, and design concept during the back check on May 22, 1997.
If you have any questions, contact Benjamin Herbst of our office.
Very truly yours,
VANDORPE CHOU ASSOCIATES:
Robert Chou, S.E.
BH:jw
c: Paul Dooley
f:ljobfiles10951BBG 1130\Field 14.wpd
MAY -29-1997 10:11
OQ�QFES,rI�; -:
cc
* Exp.
714 978 9926
-s r
P.02