9701-026 (SFD)LICENSED CONTRACTOR DECLARATION
,,I,hereby affirm under penalty of perjury that I am licensed under provisions of
-t%apter 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
5477312 R '; --,�i V3 i3 %-Yts
Date =A-) " Signature of Contractor��A'�-�'
g t'
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.
(K) 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.
(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 Section 3700 of the _Labor
Code, I shall forthwith comply with those provisions.,,
j Date:/+icy Applicant I-r.� -/.f 1
/ V
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 F
& 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 informaiion is +
correct. I agree to comply with all City, and State laws'relating to the building
construction, and her_eby.authorize representatives of this City to enter upon
the'above- mentioned property for inspection, purposes.
r, r _
Signature (Owner/Agent) j- fJ I ""Date L-7
CONTROL# ,)
BUILDING PERMIT PERMITj701-0"
� 488
DATE VALUATION' $286'383 40 LOT -2�} TRACT
311-71V
JOB SITE
ADDRESS .4-MUNCK 1VI4.Ia%AUS HOVI,bNARI)
+
APN Cn
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MI :.,aiNI) It .
K_SL DEVELOPMENT CORP.
�
56.140 PGA ALM
_50WO PGA BOULEVAkD .--
1.A t?iJIWA CA 92253
LA C. UINTA CA 922.' 3
(7760)771-3642 C1314
USE OF PERMIT
PGA WEST- JTssWTA.06PLAN _sib
PLAN 0.11,CK -Ff-.V ftJUAR- i-) FOR MULTIPLE ISSUE OF 5AI41i' PLAN
iRS-11 Oki t:ONS11i11C I'IvN 3,441.00 Sl-
lyORCIVPA' iO 519.00 St
ciA.4tr1C,IJts��i�'c'.?it'I' Sf; s.�-Ki 'i}�
CONT OF <.1;3iNS'1'�tUCTiON
2;m,33. 3.44
y i Al'��1�iTIMATEV
i'it:1K.MIT �'!'i.�, illll�'#lAX d '
t;Y.,NSTRUC.,"i 10N RE 101.4)E1f3.41 K-000 S 1,291.(9J
O AN G'1IITX FID! V61.23
j1Tl' HANI,G11 OT -13'. IO4'0{I(}4214)t (3 Si2i.(ff)
�.�3,i:.� •1i0(il1--0(10i)t0'3--4�#x190-.O(lWi1�
P4iLf.U4'sCN:93i�N14C:ittFi.El�itf1S!+.�i{1
Da6.�.ryu5
;t ['R(? NIO"1 ION (T2'ES 10I -Whiff -24!-0W
i31tAL►ItdG Io t-000-123-f}Qii S2t1.41tf
IN1 itA.`a"t'ltL."I'tfttt. 2254)Q0-44.4—,A4'd 6G,t::t(a{►.l>t3
A44T IN KJHLIC P1.AC%3 (Rr!S) 701-OW-2-ii4100 1i�fhS �i
pr
v n
�"'. ',S 31_ 3, rOTA.L C4'NSf1 iLUCTJON AND Pi.AN C14ECK
HESS PR.1r=Pi1113
MAR. 2.7 -1997
TOTAL PRIOMT FrIKS 013F, NOW
38,5"_68
01.11..4.;,41
`�..'.... C .. oi
C.
RECEIPT
DATE 11
BY'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING AP OVALS
MECHANICAL APPROVALS
Set Backs %
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing !iLlt�
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath /
Dryyvall - Int. Lath
i o
•
Final
Final 0
BLOCKWALL APPROVAtS
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
Encapsulation
Gas Piping
Gas Test
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
Final
Utility Notice (Perm)
COMMENTS: Y
Certificate of Occupancy.
City of La Quinta
Building and Safety Department OFm
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: 56-540 JACK NICKLAUS BLVD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9701-026
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
��r
- Building Official
By: DANIEL P. CRAWFORD JR.
Date: 10/10/97
POST IN A CONSPICUOUS PLACE
� C!Ty OF i A �)tjIllfT
A
�'° SPR 6 RfC°D J O N TAN DY
BUeLnISA
P 3580 Condalia Ave.
Yucca Valley, CA 92284
(619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE „LTaIRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑ I
JOB LOCATION y-6 __5LIt) J/14(/ A//eZj'gZ
, l �
REPORT SEQUENCE NO.
TYPE OF STRUCTURE ['
PERMIT NO.
Dq4 fZ
DAY OF WEEK
MATERIA DESCRIPTION
3 A -Soo
ARCHITECT
IN$C71Pd-FT_OR
VI � 1!//h'/1N/y
HRS. CHARGED
2 C_7_ 7-Z7T
6-701
ENGINEER
ASSISTANTS f
HRS. CHARGED
INSPECTION GENERAL
DATE CONTRACTOR
SUB
CONTRACTOR f S . (A,11= _0 ({
O'
2�Z �� /
CJLSE-
P443 WC /d/Lv
Play yDZ0 4 A
c a �S
iF T s.
S .Vlox
66
JoAAI
�.
COPY SENT TO CLIENT Ty
CON UED
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.
N.
I ATE ORE OF GIST S EC 9i� ��S
D T OF RT REGISTER NUMBER