9701-008 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
?4"tiS:L 3
12i11l Ars
�tef`— '�, Signature of Contractd"rtr
9 7 r Y C " ,r
Ir
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.
yI 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.
VICI 30.
(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
Dode, I shall forth ith comply with those provisions.''
ate::12APPf eAlAPPlicant '3`// � ✓ / N�,r '- °
Warning: Failure to secure Workers' Compensation coverage is nl awful 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. s
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 above-mentioned'property for inspection purposes.
,/ Qi nature (Owner/A ent Z4&,(.,- `
PERMIT# CONT�,�Fh�
BUILDING PERMITj� .,I>dlK
DATE ��VALUATION $179,19250 LOT !l! TRACT )8 f1
31 /�-�
SITE
ADDRESS M1. r♦p�~ y��c(/�♦y B1r�d�1�J
APNJOB
OWNER
tUll, ; &K0 All
CONTRACTOR / DESIGNER / ENG_INEER. _ �<
LKSL DEVELOPMENT CORP.
56-4,U) PGA 01., VD
30140 PGA BOtJLE V1V►U3�.,,
LA C,1,1(M—A CA 92253
LA QUIN1'A. t,'A 92251
USE OF PERMIT
SFIU
i'Cr`A WE- $T - nmp,1"'4AN tc,
CUSTOM C OWSRUC.IN N '2,101,0013F
PORCH/PAT M 230,00 8
CiAKA,AJ- C,1itiK)WP 636.00 S0'
ENT.MIATC,D COST OV CONST1%
PLAN C CKFlT;. i(j",I.�LI(?0-X39-313 S'7`ut.9�
ti(��.t'liy'I`RWITION ATT 101 9)043.£1-QQD $919.54
NIFXI 'ANICAL. r`W' .1011 -ON 9121-000 179.00
$143.76
ta1<1�i1fi�3lT!fG:i4+�kt;3 1.01-�3iiU-�1%9�(roA �IF,`J'.:,5
-
vr1iow"'morrioK(my'l) . :101-00241-000
�f'V�}''.t{.�.p���r����,'f��fy.. �•6..�4�}+ffl'^�fF�i�'"��i� rD.�.v��k.�
y•
4kr/.i`dAlAilVM-10N .V'St DPlt!'TN C118 CK
•RtIy4SlZ��?i�
• UWS PI.ls PAAID FLEE
$0.00
91
AL 11,11
S6,263.36
•�/}ll��_ T
w r �, , •'l i r Uig - .
pECEIPT
DATEBY
"/
DATE FINALED
INSPECTOR
4,
,.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings VAP. AOLDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap p
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
/l�JL
Final
Final
BLOCKWALL A PROVA S
POOLS - SPAS
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 /L
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 6
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
Fr
�. t3ii1'd1f N (Perm)7/111;-
Certificate of Occupancy
City of La Quinta
Building and Safety Department OF,.��=
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: 56-565 JACK NICKLAUS BLVD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9701-008 & 9704-055
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: 10/16/97
POST IN A CONSPICUOUS PLACE
- �f . �:*:� , r ..+r.--,��► .. --r- � �.�r, ... ,,..--s�'1--��..r.n+,.Fi 1. w.r'�'-^"'^.'^--r`^�- --"' .r.1 _ ..,r_ t
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(619) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE RUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JO ATION
��t (��s LA UCS
REPORT SEOUENCE NO.
TYPE OF STRUCTURE
PERMIT NO.
D TEDAY
1-qi
OF WEEK
MAT RIALSGRIPTION ���
Is1/C,J
ARCHITECT
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL SUB
DATE CONTRACTOR f:� Ls & ( CONTRACTORS • �� I
(A -1Z
S - 15 Y-3 y- 1
s t f (cP � Cmc (� —.
Dec SU
COPY SENT TO CLIENT
C INUED ON NEXT PAGE O
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.
I j)ATURE OF REGISTERED IN
Dhifi OF REPORT' REGISTER NUMBER
-3 1997 15:11
VA
'14-97S-9926
Vida ENGiINEERS
VANDORPE CHOU ASSOCIATES, INC.
CONSULTING ENGINEERS
295 N. Rampart Street, Suite A
Orange, CA 92988
Tel: (714) 978-9780 Fax (714) 978-9926
Attn.: Kim Fincher
KSL
56140 PGA Blvd..
La Quinta, CA 92253
Subject: The Ryder Collection
PGA West, La Quinta
Lot 15, Plan 3B
(Lot16, Plan 2B
Lot 17, Plan 3A
Dear Kim, -
PAGE 02
Since 1979:
Facility Planners
Code Consultants
Structural Engineers
Fire Protection Engineers
June 19, 1997
In accordance with,- your request we visited the jobsite on June 10, 1997 and June 18, 1997 to
perform structuralJob 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 18, 1997.
If you have any questions, contact Benjamin Herbst of our odice.
Very truly yours,
VANDORPE CHOU ASSOCIATES:
OQ�pFESsli
Robert Chou, S.E. w a No. S 003518 o m
d Exp. 3.31 -00 4
AB
c:. Paul Dooley �'9T OF
�F�Q,�
1'\jobftles\095\cypI I26\fie1d20.wpd OF CA1.
I