9701-021 (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
Date f Signature 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:
Cartier Policy No.
7rURAC11 iN ,3,
(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 Sectioh"3700 of the Labor
Code, I shall fortwit comply with those provisions. ff Y i r
Date:'' ��"? Z4 Applicant ffcr � ��l. !.
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 t
for a permit subject to the conditions and restrictions ,set forth on his s
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 all City, and State laws relating to the building •'
�tc,
Astruction, and hereby authorize representatives of this City to enter upone above-mentioned propertyyfor inspection purposesgnature (Owner/Agent)
r r' - W
BUILDING PERMIT PERMIT# CONTROL# ;
�f7f1i•fi3� 4879'
DATE '� VALUATIONsa.*t.vi> LOT TRACT
f(2 r! ixaf+
(
JOB SITE
ADDRESS 54,390Jf t.K iNiCK1i`.AUS 11OULEX)i, U)
APN
761-5.50-1335
OWNER
CONTRACTOR / DESIGNER / ENGINEER r �1
LK
KSL DEVELOPMENT CORP.
St.
1114•10 KA BLVD,
561.,10 PGA C30ULb. V.t't1. D
1A (40491-A ,A NV:3
LA QUINTA CA 9225�-
7€ 017711-16 42 C,RLf
USE OF PERMIT
3YU)
KfA WEST -• f:[[sW1 Wl 63 PLAN WC
CUSTOM C'023S`I'12UC 1`ION 2,655.00 S
I/Of(CAVPA IO 3tr211W 8
QAKA(J1'/+ Ak11: k1' 71300 SP
anuit, e1):josro 0���1���'a.►'.,I�)�a���
224,81-.9(1
.1011 611 .�+y 1N, STTt�iMA Y
Ct'jivSTRUC:` ION FRE 1011 00-41.843()0 SA,077.0
PLANCJ4rtrX 301,0110}439-31.9 $817.29
VUIC''NUCAC.TEIS 1131.01 - -GOC) 9164.69
P)AfA9W,N,(91?EPS ' 1011.000-4y1A9.00100 $.185.25
.S'�.�R.0.t4GN!O'r10-N(i�i ) .. 1014)1�•+Fr's1.'01) $22,48
: ti1�3 104-000-423-000 Za.{l1Z
lid:tt 4t�;:"l,'iJt 22-'400-443-342 U,967.98
Alta' 1N P1Ji34TC ILA (RAS) 7101*i W -25$x 04:19 5 1w.�34
o s-=
LESS TR13•-.PAYD THEE
+
$0.00 • .
1,0TAT, >ni�TT.M: T )� FMS "aG U �lVMAI
$7,705 .73
RECEI�P.,T, `�+ `-bATE
BY I/
DATEFINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings A
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap %
F.A.U.
Framing /7
Compressor
Insulation 61.1Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
0
Final
Final
POOLS - SPAS
BLOCKWALL APPROVA S
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 I
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas TestIV
Appliances ol
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
ollowing.
BUILDING ADDRESS:
56-390 JACK NICKLAUS BLVD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9701-021
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 QUINTA, CA., 92253
By: DANIEL P. CRAWFORD-JR.
Date: 10/3/97
POST IN A CONSPICUOUS PLACE
CS�' Cam C�
R16C JON TANDY
'yam= i
3580 Condalia Ave.
� jYucca Valley, CA 92284
(619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
so STRUCT. STEEL ASSEMBLY ❑
❑ ASPHALT ..P-,OTHER�
❑ FIRE PROOFING /
JOB LOCATION ^0 �4�IV �JAvs
/
7J_
REPORT SEQUENCE N0.
TYPE OF STRUCTURE )
PERMIT NO.
D h
DAY OF WEEK
MATERIA ff. CR T)ON ^ SD
l�0140
ARCHITECT
IN_S CTTOR
HRS. CHARGED
1HRS.CHARGED
7-v7-- /
E- E7-7
ENGINEER
ASSISTANTS
INSPECTION GENERAL`/
DATE CONTRACTOR 1 ♦ . S • L
SUB ( � �( R '^ /
CONTRACTOR - S W-0 It/ tic'-
GIS 6A . T S• 5X 10X'111
IfQ L s
Jv/ Fp-
COPY SENT TO CLIENT
CONTINU 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.
Si NA U E OF EGI ERE D INSPE OR .r�q7�
1 q d
DATE Oq EPOR REGISTER NUMBER
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:
QROESS/O
Robert Chou, S.E.
BH:jw
CO
W m No. S 003518
cr C)
Exp.3-31-00 C z
cf '>q�F9UCTUPP
c: Paul Dooley OF CAL�O
f:\jobfiles\095\BBG 1130\Field 12.wpd
- VANDORPE CHOU ASSOCIATES, INC.
Since 1979:
VC A
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, 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:
QROESS/O
Robert Chou, S.E.
BH:jw
CO
W m No. S 003518
cr C)
Exp.3-31-00 C z
cf '>q�F9UCTUPP
c: Paul Dooley OF CAL�O
f:\jobfiles\095\BBG 1130\Field 12.wpd