9701-011 (SFD)LIiENSED CONTRACTOR DECLARATION
I hereby iaffirm 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
1773.2
Date �z ef- 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:
Carrier Policy No.
WfUCH
(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' compe sn atlon. provisions of Section 3700 of the Labor
Code, I shall forthw,jth comply with those provisions.
Date: j Applicant ''�
Warning: Failure to secure Workers' Compensation coverage Is unlawful and
Shall subject an employer to criminal penalties and civil fines up tOr$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,agentsand 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 tlie above information is,
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby auutthorize representatives of this City to enter upon
.. r . - _ - '. ..
re (UwnegAgent) faFac yrs i. .+ fr, V. F uate�g.
BUILDING PERMIT �PERMIT_# CONTROLk
6:S
-77t„t_�I,- 4 8
DATE 3�'z 7/1 � VALUATION Z11�S��i 2. ]t� LOT � � TRACT wtt ,JOB
SITE
ADDRESS �tii•.c�:1.s1;1{..�� �1�.{. ,�.�ai�:Y a{��.I�� "'vi1,Ri�
T4_76J-350-021
OWNER
CONTRACTOR / DESIGNER / ENGINEER
;KSL DEVELOPMENT CORP. ,
?til40.if ;A 11C)U U VAtd.Ij
'►.f1, Qt3IKI A CA 9225 3
LA. QUIT rrA CA 92251
(70)771-1&12 C11 -fly
USE OF PERMIT
i4j'A idJ s 3`i' - R't DER U44041 3C
t+%Anr 6�t f gid' t7 tJ cca I� a�2 a # t �t� 1 t,}�.'elt�ta ts',(f1; QF SAN3r PLA:td
01ST'OMC.IONSTRUM014 2,450.00 SP
POACMWAT.10 _44100 SF
c�ttss�r cat�.�r�3z.r: 5x7,W St-
=T11% ATJ1.D-(,t 'OFCONSTRUCTION
.04.442.70
KAN CfMCK RA 101_000-o,941.8
Ca{F3I*d t`l�fUyC`{,d'YlOi1NyI�TE S!,104)7 100
!1011-000-418-0x00
1tifti5!ii':�D�l,YMr�t+.ltLL. ♦',�i{75 .i..V!"Oi�,Sf '^Id�iO �JxilE�
WXC:Tt tt .C3AL Ffi9.
tst,t7' tNC �T3F 1014)00-41:9.000 $167.71
5 zcz,W1. O TIO ON (MEM) i 01000-24 i ,�Mo
4123»0E30
Clidl3lNa i 1y.{ry)1
�-((�}�t/1�
' - 6f.vb•:GCf'1+3���j14.�.V.f.S37. , &FJ'dVV"+i���� ��'���L�7�''.C7Y
.
ART iYd.iJtfk�i tC, A1�i�C {f S) i�11.-000-251 -.000 SG$k.11
F 1� Y1"ti'.�::�. �'C�A1�1421,f�1*Iow AND;t51AN f�1I1'r�'`#�,
$6,4505
.ESS PU AWD`RES
.$0.00
-;MAR . 27 1997 .. TOTAL P]. Xf l gf RES DUR,'NOW
196j���a.t)s
I : Qi 9;NAMAi
RECEIPT
DATE - {
BY
DATE FINALED
INSPECTOR
`,A _
INSPECTION RECORD
VA
+OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings J,711 A
Ducts
Slab Gradetj
Return Air
Steel
Combustion Air
Roof Deck /
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation p 77A 4
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Dryyiall - Int. Lath
Final
Final /
POOLS - SPAS
BLOCKWALL APPROVA
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING Aff ROVALS
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 WIZ 2
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)
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
❑ POST TENSIONED CONCRETE O ASPHALT
❑ REINFORCED MASONRY O FIRE PROOFING
O
O OTHER
JOB�LL.•JJ•
((kk
��fTION
N
A
REPORT SEQUENCE NO.
TV�O�fj.LLCTURE
PERMIT NO.
TE
Etr ��_��
DAV OF WEEK
MATEJaIALULSC IPTION
14 r
ARCHITECT -
EOR,8
HRS. CHARGED
/ T /I
ENGINEER
ASSISTANTS I
HRS. CHARGED
INSPECTION
DATE
GENERAL/)��� SUB
CONTRACTOR S F CONTRACTOR
` �
Li
12(ms'
�12GQ IIPAS�
t 14
6+
fATF,S r Cp HeC-C-7 fltJ
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LZ.✓J liv a-
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT 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.
�GNATURI
ATE OF REPORT REGISTER NUMBER
r,I193 15: .F 714 7 9 7 8 26 ENGINEER PA G E ,G
�-r _�
VANDORPE CHOU ASSOCIATES, INC. Since 1979.
CONSULTING ENGINEERS Facility Planners
+ 295 N. Rampart Street, Suite A Code Consultants
Orange, CA 92868 Structural Engineers
Tet: (714) 978-9780 Fax (7141978-9926 Fire Protection'Engineers
June 30, 1997
Attn.: Kim Fincher
KSL
56140 PGA Blvd.
La Quinta, CA. 92253
Subject: The Ryder Collection
PGA West, La Quinta
Lot 18, Plan 1 B
Lot 19, Plan 3 C
Lot 20, Plan 2A
Dear Kim,
In accordance with your request we visited the jobsite on June 18, 1997 and June 30, 1997 to
perform structural job walks for the subject houses and found the structure to be in compliance
with the plans, calculations, and design concept during the back check on Juno 30, 1997.
If you have any questions, contact Benjamin Herbst of our office.
Very truly yours,
VANDORPE CHOU ASSOCIATES-
QppFESs10
SUN �9i
r
Robert Chou, S.E. �� ao No. S 003518. IT!
� O tJ tro:°
Cr- Exp. 3-31-00 (z :�7;'
AB
T'9UCT\)
c: Paul DooleyF Q�
f: obfiles10951cyp1126\f1e1d23.wpd T OF CAUF�
Certificate of OccupancyAw
City of La Quinta
Building and Safety Department � FMOF
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: 56-455
JACK NICKLAUS BLVD
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.: 9701-011
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:
10/17/97
Building Official
POST IN A CONSPICUOUS PLACE
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