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9701-118 (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 7"ofessionals Code, and my License is in full force and effect. -d`icense # Lic. Class Exp. Date 541 N; ate � •„ / Signature of Contracto r � f � .. r v 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&RC. 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. ZU.1210.1 INS. CO. WC683896505 (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, s bject to the workers' compensation provisions of Section 3700 of the Labor 'Code, I shall forthwith comply witftfiose,provisions. Date: M f ^�' 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 issuanceof 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 property for inspection purposes. Si nature (Owner/A ent) s�/*' ). , •t 1 + f --'�",-Date/ 7/'` PERMIT# CONTROL# BUILDING PERMIT `�"►�_ � 487 � ' VALUATION TRACT DATE 'j/2-1 Iq JOB SITE ADDRESfS :7 ali�{:�A,i�I{i.wf.�1J�3i.sV"C�[�J; Ti�_ 7G1«S:1E%��• OWNER CONTRACTOR / DESIGNER / ENGINEER (. A;1+ rj I KSL DEVELOPMENT CORP. _56t40 PGA. WULE VA.RD 36-140 PGA 8> .VO. I.,A. C3llFN'1 A C.A. 92753 LA. QUINT C"A 02233 (.7ist3'�i71.-3f 12 CI3L# USE OF PERMIT SF0 PGA W080- RYIDW PLAN 2A Z379,00 +3' i OItCi t/f'.A fC) 4-02.00 Sr' "ARA (WCARP0RT 62 .00 IF g9.%��►�1'.�2!'9:r�'i'ilt3 C:`0�1:' �' �:.'�tti�'�'1�1.1%�°t01`+T 2i1#3t�U�.S►!i �( pp�.{{����'' {+ { y� dq'dANC WEC''r, FIEF f.a1 �l(?0- 313%R St3i�:2� CON113TTWOMOX.4 FiCE. j ii-d3(1()� •l.€� 4Y,?f1 St193•lt{) MECHANICAL.FfFS 101.MO-421µ000 10.1009-420-10" $t5;,21 f1i iT_ ft-fatNOT FIX. 8 ;WRirdCf hL'f it?iy (:!°1 tl}1wffiA 2I-iltlfi �2dl.t?2 C RAPIT4 3 l0l•tZOA- z3*OOH .120.00 rN€:t � sc t'ct 275.0001443Mi 42 S4,444.09 AfCr IN KfEALTC. Pt -At 9,q fK SI 701 -ft) -255-000 $250:io a y R-170UL C',0NS#'ltt, CT1oN AND PLAN CKF.CK -W,.R.81 P. LESS P,F_P.A:i;J t° 1: S $O.O© TO .'AL RERMIT �,R�;.N.��Ut NOW $6,968;8a MAR 2 7 1997 CFY 'G- i__�t_ �i BIZyi RECEIPT DATEBY ` DATE FINALED INSPECTOR INSPECTION RECORD 'A OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS A. MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel till, Combustion Air Roof Deck lj Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath "O/zvz— _S111017 /DlL Final Final POOLS - SPAS BLOCKWALL A PROV 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 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 'lily 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: Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: VN 56-415 JACK NICKLAUS BLVD Owner of Building: KSL LAND II Building Official Bldg. Permit No.: 9701-118 Land Use Zone: RL Address: 56-140 PGA BLVD City: LA QUINTA, 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 TRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE ❑ ASPHALT 0 OTHER 0 REINFORCED MASONRY 0 FIRE PROOFING JOB TION cc t< �s LA 0-0ILeL REPORT SEQUENCE NO. TY -`� �11C/I . p(LLDDE/KS/•-J\ PERMIT N0. DA • a yl BAY OF WEEK MATER P;40N %�. V Il r'0O ARCHITECT INqPFCIOR HRS. CHARGED l ENGINEER ASSISTANTS HRS. CHARGED INSPECTION GENERAL SUB DATE CONTRACTOR K -S L Oeo ( , CONTRACTOR S . I G, o A. _B4Se- -P 71ZS TOP 6O13t4 ec-rL ot, A 6eC v-, � 3 COPY SENT TO CLIENT C TINUED 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. SIGN jLURE Of R GISTE E INSPECTOR, DATE OF REPORT REGISTER NUMBER Attn.: Kim Fincher KSL 56140 PGA Blvd. La Quints, CA 92253 40000MIMP W. VANDOPPIE CHOU ASSOCIATES, INC., 295 N. FlarnpE-(( St"eall, bulla A Orange, QF, 92868 Tel: (714) C178-3780 Fax (71W 978-9926 Subject: The, Ryder Collection PGA West, La Quinta Lot 18, Plan I B Lot 19, Plan X May Kim, POO: its Since 1979 Facility Plcinnws Code Consultants Structural Engineers Fire Protection Engineers June 30, 1997 in accordance with your request wv.,isited the;obsite on Junt- 19, 1997 and Jurie 30, 1997 to perform structural job walks for the subject houses and found the structure to be in compliance with the plans, calc,.ilations, and design concept during the back check on June 30, 1997. If you have any questions, contact Benjamin Herbst of our office. Very truly yours, VANDORPE CHOU ASSOCIA: 0 Al� U N iu Cn No. 'S omf)" 8 :x IYl 1' C: Paul D0011CY f,,yobMesk0951cyp1 I26TieId23-%;pd 11 �' � Robert Chou, SE, F.W.61 13