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9701-014 (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 54773 2 Date J•,j? yf� %Signature of Contractor h Z *"'� ��• �'•+""� 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. Se( ) I have and will maintain workers' compensation insurance, as required by ction 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. ZIJPII(311143, (110. WC68389650 (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:% • "` Applicant % �'�/ # �-''�. "^�r'`.�-•-r. - 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 for 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 hereby authorize representatives of this City to enter upon the above-mentioned propertfy for inspection purposes. + Sinnature (Owner/A9ent) f�'x..��1 - Date 4,77�a' _ PERMIT # CONTROL # jjj BUILDING PERMIT 970)1-1 1 48 DATE �7 / 7 VALUATION S-244,442.70 LOT 2 TRACT 283.91 1 OB SITE ADDRESS -56-32-5 JACK NICfij�lll�� �1����a.�.��t��� APN 761 -MO -024 OWNER CONTRACTOR / DESIGNER / ENGINEER _ KSi.1,A)"ID H !KSL DEVELOPMENT CORP. �6 NOI'QA BLVD, 561,10 VAN I.I.A.QUIN'1'A CA 9 Z.43 LA QVINTA C'A 91.2:51 C 13MI USE OF PERMIT SF1'1 P0 WEST - R'tU-'R PLAN 3139YE PLAN CHIK:K 07,13 HE1)A) iiok tviourwix (,8S(9-'F(,8S(9-'O SANTE KAN ' CIMTOVI CONS'1'1tUCTECN 24500) S (4)RCH/L'ATIO :.A5.(k) S 0ARA000C:At2lri)RT ,217,00 `N7+ V%IJINIXITUa C (W1' OF C:ONStRUCTION 20,442.70 PLAN 01FM. " 170-7 101 -WO -439-311 $205A2 PTH 101 -OM -418 -OW S1,(X)7.00 MECHANICAL F171 -I'S 101.000.11",1.-tlN 3V'29.() IsL,1sC-i'ttic ,ii, [ 1 L 161 -000 -420 -OW 3017V . F�1.£fiViT;llidCl �1.L :� till•LM)l3-+1lS�Lli'1D 5167.25 . ,`i;'1i.{<'+NO N110 f'fc7N 111.1-•_ A% 41 (ti410 $30, to t',1�ri(titr'C"+ 101-000-•123.111)01 1NPRAS'1' X,I'1Ittfs r115.0O3 413-3.42 543a6,(A ART 1N 4rtftJXf 1.+1.ti MS 1XM(IMS)701-C 00-25.5.000 S,2ti1.1s i r: PS I -110I`X41.. C 0NS"r1tTJC' n0_N AND FLAN C H4 CK WR _, LOSS PRf-,4Y%1D C FtS $0.00 MAR 2 7 1997 IOTA]IOTA]11CR IT F1 AUS 1314: NOW $6,454,05 JX �t ill- • ���'�� 1 ' f [RECEIPT DATE i EyTALED INSPECTOR INSPECTION RECORD OPERATION DATE I INSPECTOR OPERATION I DATE I INSPECTOR BUILDING APP OVALS MECHANICAL APPROVALS Set Backs / Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap /ai F.A.U. Framing / eL Compressor Insulation L Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. LathAr Final Final 0 7 7 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 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) 01 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: 56325 JACK NICKLAUS' Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9701-014 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building:- KSL LAND II Address: 56-140 PGA BLVD City: - LA QUINTA., CA., 92253 By: DANIEL P. CRAWFORD JR. Date: 10/27/97 Building Official POST IN A CONSPICUOUS PLACE 07/10/1997 07:14 . 714-978-9926 Ann.: Kim Fincher KSL 56140 PGA Blvd, La Quints, CA 92253 VCA ENGINEERS VANDORPE CHOU ASSOCIATES, INC. CONSULTING ENGINEERS 295 N. Rampart Street; Suite A Orange, CA 92868 Tel: (714) 978-97ao Fax (714) 978-9926 Subject: The Ryder Collection PGA West, La Quinta Lot 21, Plan IA Lot 22, Pian 311' Lot 23, Plan 2C Lot 24, Plan 3A PAGE 02 Since 1979: Plan Checking Building Inspection Code Administration UBC, UFC, Title 24, ADA July 10, 1997 Dear Kim, In accordance with your request we visited the jobsite on June 30, 1997 and July 10, 1997 to perform structural job walks for the subject houses and found the structures to be in compliance with the plans, calculations, and design concept during the back check on July 10, 1997. If you have any questions, contact Benjamin Herbst of our office. Very truly yours, VANDORPE CHOU ASSOCIATES: '�evll� �- Robert Chou, S.E. BH C: - Paul Dooley . fNobfilesW93kypl 1261Ge1d26.wpd JUL-10-1997 08:20 QpfESSlpM �Q��`o�EU1VCy `�ti , cc No. S 003518 o m d EV. 3.31-00 C s�qr �ucTv�`�'Q P OFC 714 978 9926 -AA REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 3580 Condalia Ave. Yucca Valley, CA 92284 (619) 365-5045 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ><TRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER ❑ REINFORCED MASONRY ❑ FIRE PROOFING .�� j �n JO y - � q 1C 14 k_J CA ' V o" T A J REPORT SEQUENCE NO. TYP F' R CTURE D . PERMIT NO. D E DAY OF WEEK MATE L D I?TION ^� J� ARCHITECT IN P CTOR HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION GENERAL CONTRACTOR L D ( SUB DATE w CONTRACTOR Cel©� W G- `�' �-�-- &021<C -1n �A (�o ec?t otel [ T E-�-c -T'S . / o x �/ s COPY SENT TO CLIENT 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. oG SIGNATURE OF REGISTERM INSPE DATE OF REPORT REGISTER NUMBER