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9701-010 (SFD)LICENSED CONTRACTOR DECLARATION l 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`s Signature nature 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 ( ) 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. 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. (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�u�bject to the workers' compensation, provisions of Section 3700 of the Labor Code, 1 s all forthwith comply with those provisions. 9i Date: .' z /Q"7 Applicant- -11`4 ` I A f (• �s° �z . �. ct '".. 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.q 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 construction, and hereby authorize representatives of this City to enter upon the e above-mentioned property for inspection.p.urrppo,,ses. ,, / , .. Si nature (Owner/A ent)1 � . 0 11 1• �''" 1" Date 2- 7 - `4 PERMIT# •.CONTROL# BUILDING PERMIT �711�-010 48 8 DATE /�� VALUATION $179,192_1% LOT �� TRACT 283- (y �!� JOB SITE ADDRESS 544190.5 J'Alk ll, Nj%CAU`i DULEAfLRD APN 61-556 24 OWNER CONTRACTOR / DESIGNER / ENGINEER t51. T. to" t KSL_DEVELOPMENT CORP. 56-144)1,1G.A BLVD. }'CU BC,� F WARD LA.r,1JJR1J`1'A CA. "51 LA OL.fINTt1 CA 92251 (700)771--.'., 4i- CD11# USE OF PERMIT .PGA. 'W S'F - 10119R PLAN IS tit:A}a C ilk+'l�Iti l"f is 1tPOlic" ED FOR NV41J .T.1F':I.T;188f:X OF 3t1HE k'LAN i3 '3 ,Tv_r. '�y2v a`T KIJ "'tui l 10 1. 00 TF PORQ'itlWAXIC, 230.00 SF OAR &t.}:aCA:1211%JRT 636J)031,-" • 3?:��'� iIL3z�„l,A;� Csd,�:��(`. t;��':v��tS �'�:t3L"!'1t}� :d73.8�D�,:�(! 'i,A +tC tF i� f L 1.t)l.ai)i tt-�3c >31 ;lK8.74 AJEC.Hr-1 M,ALt, 13:r;'S - t LE0li, CA1,14 3. S'f;43.x6 J;'l,t��tfif€dr:si+ixtd�t tt}� f30(}�19�000 $4.(17.2:4 -�(1��'+t��.t�.t Iflt�fl23�i100 S2t7.r)I:i 4 t f tAS ' ( TCOW.—­ 2 w'..O04)- # - 2 ART :113 Pitmic`3 rA ,f\ais trtr.i59 70.1 -WO -255,0{10 S197.98 '.? LOSS RE.Pl ;i 396 '611,011 BAR 2 7 X997M°�r:NOs,®7.:s RECEIPT DATE. BY "' DATE FINALED INSPECTOR ` M= INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING Af PROVALS MECHANICAL APPROVALS Set Backs W&WUnderground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Root Deck I-5 Exhaust Fans O.K to Wrap F.A.U. Framing &W ` 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 BLOCKWALL APPROVAILS POOLS - SPAS 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 7 Encapsulation Gas Piping Gas Test p 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 F,pal a 44� Utility Notice (Perm) COMMENTS: _W 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: 56-495 JACK NICKLAUS BLVD Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9701-010 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: 10/10/97 POST IN A CONSPICUOUS PLACE i JON TANDY 3580 Condalia Ave. Yucca Valley, CA 92284 (619) 365-5045 REGISTERED INSPECTOR'S WEEKLY REPORT TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE 4SPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ ❑ OTHER JOB 10N � � � I ^ � 1"t /N O. REPORT SEQUENCE N0. TVP F�SSjijnRE PERM/IITT DAT DAY OF WEEK MATERIAL ESCRRR TIO ARCHITECT I R HRS. CHARGED I T ' ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE GENERALSUB CONTRACTOR KS L (Jt CONTRACTOR Z� 4- Vx &S -s -L6 kp '047 i top o w m -fl ot'l (A-027 C. .� � � � C�Z.i/� c �(� C� ✓tom � Lem_ or COPY SENT TO ;1K I CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE / 'HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THF. 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. y �SI NATU,OF REGIST D INSPECTOR _ � DATE OF REPORT REGISTER NUMBER C"A' E1+51NEERS' VANDORPE CHOU ASSOCIATES, INC. CONSULTING ENGINEERS + 295 N. Rampart Street, Suite A Orange, CA 92966 Tel: (714) 978-9780 Fax (7141978-9926 Attn.: Kim Fincher . KSI: 56140 PGA Blvd. La Quinta, CA 92253 Subject: The Ryder Collection PGA West, La Quinta ---Lot- 18, Plan 1B Lot 19, Plan 3C Lot 20, Plan 2A PAGE 05 Since 1979. Facility Planners Code Consultants Structural Engineers Fre Protection Engineers June 30, 1997 Dear Kim, In accordance with your request we visited the jobsite on June 18, 1997 and.June 3D, 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 June 30, 1997. If you have any questions, contact Benjamin Herbst of our office. Very truly yours, VANDORPE CHOU ASSOCIATES QppFESS/o ulvefor Robert Chou, S.E. �0 cn No. S 003518 tri O = d Ev.3-31-00 t„ AB �p S UCT\)?Iy, c: Paul Dooley ATF Q� V: obfiles\095\cyp1126\tleld23.wpd OF CA1.�F�