9701-023 (SFD)LICENSED CONTRACTOR DECLARATION
I aereby affirm under penalty of perjury that I am licensed under provisions of
!'"_hapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # L c. Class "'��e Exp. Date
'Sd77Z 15 �""t"' i 12 1/tint
Date Signature of Contract rr{�'"'t
1� f
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
pert rmance of the work for which this permit is issued.
(`�) 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:
Carrier Policy No.
.'c.IJ`I2ICI1 1145. co,
Wer, f WO°+EjS
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) -1 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' compensat o provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. `
Date: Applicant n`
� r _.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify '
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information i's
C
orrect. I agree to comply with all City, and State laws relating to the building �
C nstruction, and hereby, authorize representatives of this City to enter upon.,',
,tie above-mentioned property for inspection
1pu�poses, %
Signature (Owner/Agent)f + f +(� j _ ater/
PERMIT# CONTROL#
BUILDING PERMIT
11 y7„►.�►t 488
DATE VALUATION VALUATION 5224,815,9►► LOT �� TRACT 1691.101
I
`
JOB SITE
APN
ADDRESS iti-44XUt4i.:K Nk'K1. 11.1 110111,10. 'ARD
761-5+11-037
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KSL DEVELOPMENT CORP. W
X) -Ho PGA BLVD.
56140 11G BOULEVARD
U. QIJIMI'i\ CIA 922 ?
LA QUINT -A CA 92253
�7t�!)'T71-3t�/12 Cal.#
USE OF PERMIT
POA W t'sS #' - id-Ri"t'MN PLAN ii51't
PLAN (.11RX FOR 1+,1411; I1PL[: 0 SAAB; PLAN
Lf)sn m GUNS`t' uc CIoN 2.655.00 ill
t�i;tlt�:tUk'ATiU 'Jfl2.tJtJ :+i�
GARA(7VXARtJC)KT 713,00 S?/
C'(:11!f5'"!'I�.r[t�'!"IUi�3j-I'� #Qi-i}fiC}-•'i1$-U�fl Si.ii7°7'.Oi)
PLAN Ct141MN F F6 1111_ -OW -419.314 8':!9.34
MWILANICAT FM 101-00"21.000 x��.�x►
110MRICAI, i+iifiS -I014W-420-000
IxtXMIRNO lS 101-000-419-000 S 1135.�S
"MRONO IbIOT1ON (R -?US) W40.241-000
ORADMO 10.1.000-423-000 x2 .Qv
1NFkAXi'0Cf 0RJi 225-000-44.V342 54X7,"
ART IN I't1kA.1G PLACES, (KRS) 701-41X1-255• S;1t104
5(.IE3-'OS'! L C(3WRI'KLMON AND P4AN avcK
S7,N7.74i
i' C LUSS MB -PAID FrU.E.S .
$0.00
'I MAL PRIMIT FRUSTHIF'NOW
$7,041.76 '
MAR 2 7 '3997
-
:. s
RECEIPT�——
DATE"• — ' ` ” ` ;
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
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)
Certificate-of0c'cppan'cy
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:
56-490 JACK NICKLAUS BLVD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:
Occupancy Group: R-3 Type of Construction:' VN Land Use Zone;
Owner of Building: KSL LAND II
Building Official
9701-023
RL.
Address: 56-140 PGA BLVD
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 10/8/97
POST IN A CONSPICUOUS PLACE
CI ry
Op tATANDY
�'�''�.T�N
APR � 6 REC ;.
3580=Condalia Ave.
REGISTERED INSPECTOR'S WEEKLY REPORT
-Ii/V&Yucca Valley, CA 92284
x(6'19) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
-42r'SlTRUCT. STEEL ASSEMBLY �� ����
❑ ASPHALT HE
❑ FIRE PROOFING
JOB LOCATION _ {A� 41/� r
V/ L/J,"�t
0� /
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
���
PERMIT NO.
4E dp'�
DAV OF WEEK
MATERIA DESCRIPTION
36 A-3ov
ARCHITECT
IN9P E R
aJl
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR S , L
SUB y ,
CONTRACTOR 1 Z �J
7
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COPY SENT TO CLIENTX
ON LIED ON NEXT PAGE 0
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,NATURE F RE TIERED I PECTOR� ���
D E OF E RT - REGISTER NUMBER