9701-119 (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
34 7732
t' a Dat� A � �' Signature of ContractdL I IV,, 11' e,
v � I g � �
U OWNER -BUILDER DECLARATION
W W
I— D_
U)
Z
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.
00 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:
Carter Policy No.
7A)KNtL .INNS. CO; 6'4`C 683f396505
(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
�ubject to the workers' compensation provisions of Section 3700 of the. Labor
Code, I shall forthwith comply with th se provisions.:
Date: i'7'' /s�'IApplicant i�l�.',J/ 1A i
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 personrat
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; ihdemn'ify
& 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 epter upon
t e above-mentioned property for inspection purposes.
Signature (Owner/Agent); J 01
. BUILDING PERMIT PERMT# CONTROL#
DATE ' `-7 VALUATION
`^7 j p VALUATION . f LOT 1... 1 TRACT aid i
JOB SITE
ADDRESS t\I.1��t�A�Jn9lTtfi�jl?.all.� t`l.�D
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
KSL DEVELOPMENT CORP.
561,10 POA BOULEVARD
St5-14011GA BL` D:
1.A. CTO fNTA CA 922-53
1,A Qt,t4N'1'A CA 92253
t760MI 1.3542 C;Bf, f
USE OF PERMIT
PLAN P. HWC,iC I `EE; .fit VIXJC'Ii) F01t iV'klit.'4'iPLF, ISStil' (0 3AW, PLAN
CUcj`1`ia:%v1 %OKa°1RCTC110N a^,, i>fl.fit) ."y3
PORCWPAY40 zvm v5V
1;.ai�lFJ4�.�rFJrE'I�1!`EkT�?Tt�• tS�1U.ftfl T+i
it 'STIMAT-C.:>10 COST Or, C'ON.STRUCTION
1.7949 .50
-MAN CRMK TEE
CC7RTYR4iC't'ION F129tt3, C► " 3 -0 ��� . �
AliiC INNIC AL MOS. . 101-t 010I.- a1-000
�.4�!'1�Ic;A1, �1Eis'�.. ' • `. �0,i,-(i'4G-��'(!-4{l(� �:I�1�.'�Ei
i•'..•tftblii7;NGth.MS $167.25'
a'!'R.ONi 114iO'I 10.14 101-000,241-000
ItAt7iti .101.000423.0.,0. S Ci.t3t}
:1W,RA:i`.1`Ut:"1' Wi —4 T25-000-44.3..34:2 $3.9040
At T 1K f 1.f8- lC P? ,AC."tom MR 3) 701-00..0-255"600 S;t97.98
Y
- 4
�" .. ' 8•` 1� r"AI4.STRUCTITIDN tlNY) PLAN C14 C K
1V1!,, -PAR) LS
$5,697, 4 5
${i t2CT
LESS . i '
,MAR `� 7.1997. � OTA ;P.F11RMIT f%V.S.DUE,,74OW
RECEIPT
DATE"
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR'
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/
Underground Ducts
Forms & Footings
1414 A
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K to Wrap 7
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
/ v
s
-
.
Final
Final
BLOCKWALL APPROV S
POOLS - SPAS
Steel
Set Backs
Electric Bond
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
24
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
i
Final
,,Utility Notice (Perm)
COMMENTS:
`
"
`Certificate of Occupancy
City of La Quinta
Building and Safety Department
J
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: 56-375 JACK NICKLAUS BLVD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9701-119
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND II
Building Official
Address: 56-140 PGA BLVD
City: LA O.UINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 10/17/97
POST IN A CONSPICUOUS PLACE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(619) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑
O POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB 710395 -Aci� OcKlao-& / ,,
\JI (
REPORT SEQUENCE NO,
TVP F SIB RE
1��LL//JJ\\
F.
PERMIT NO.
D T
DAY OF WEEK
MATE L D PTION
_ (J
ARCHITECT
IN PP TOR
HRS. CHARGED
/f
ENGINEER
ASSISTANTS
HRS.CHARGED
INSPDATE ECTION GENERAL SUB
CONTRACTOR KSL �v f CONTRACTOR p- S C II, ' �J G-
�� coN tJ PL -p ot-1 i gq-e-� (-��--
�S �3x� Go(-
f4z:>Comax0ed
4P a
�iSi U�`Te.S`1�N
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.
V -71 —"s"'
�IGNAT�AE OF REGIS ED INSPECTOR7 jz-go
DATE OF REPORT REGISTER NUMBER
07/10/1997 07:14 714-97879926
Attn.: Kim Fincher
KSL
36140 PGA Blvd,
La Quinta, CA 92253
Subject:
Dear Kiln;
VCA ENGINEERS
VANOORPE CHOU ASSOCIATES, INC.
CONSULTING ENGINEERS
295 N. Rampart Street. Suhe A
Orange, CA 82868
Tel: (714) 978-9780 Fax (714) 978-9926
The Ryder Collection
PGA West, La Quinta
Lot 21, Plan IA
Lot 22, Plan 3B
Lot 23, Plan 2C
Lot 24, Plan 3A
PAGE 02
Since 1979:
Plan Checking
Building Inspection
Code Administration
UBC. UFC, Tice 24. ADA
July 10, 1997
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:
Robert Chou, S.E.
BH
C: Paul Dooley
f. 0bfi les10931cyp 1 l 2611 eW26. wpd
JUL-10-1997 08:20
Q�pfESSI
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CQ No. S 003518 T m
M d EXP. 3-31-00 C
41
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714 978 9926