9701-007 (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
12/3 08
Y,,,r
347732
hate -171, '� 7Signature of Contracto
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.
(A. 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.
Z`I;(Ifi.:f:H IN 3. CO.. �'�"�i "•i3Jr��E1�
(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'provlsions'of'Section 3700 of the Labor
ode, I s alrforthwith comply with those provisions..rP
Date:-/%f"ir Applicant~ fi1:` r 4
Warning: Failure to secure Workers' Compensation coverage�s� lawful 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 f3
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
correct. I agree to comply with all City, 'and State laws relating to the building
c0struction, and hereby -authorize representatives of this City to enter .upon
t e above-mentioned property for inspection pup es. h
Signature (Owner/Agent).
{ r
' BUILDING PERMIT PERMIT# CONTROL# ,
{701►4H)7 4 50 5
DATE VALUATION # LOT TRACT
Al
JOB SITE ADDRESS 56-51^5 JA Hil*�. 1`'4`iCKLl�AUS ii3il.iGi�.`�/1�.RD
APN 761-55-50-016 1.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
..ND1 It
((KSL DEVELOPMENT CORP.
36-140 PGA BLVD.
'?o140 PGA B:}U,EVARD
LA %fINTA, Cts. 922—SI
Lt1. QiJ.[NTA CA 92753
(760)77'I.364"
USE OF PERMIT
�j:tfw?
y
.'Plil4 WrIIS`I' -12Y` EM, KAN :30
KAN L i E.CK FJX EXJIJCk'. � FOR MULTIPLE ISSUE ti.F ,.C."WE PLA --..N
t(ry�,t(��1.i.1�.�tVi .aOINSJ..RO).. T 103450,00 &W
ry� /�Y [��+
.T"Ls114... f%C'tirl �V 245.00 w1L'
GARAf" 10CAfZPOW1 527.00 SF
204,441.70
PEP1�1i'.1
lir :1014x
fiONf>:f`kUCT'I,ON F0.", $1,097,00
NWAAMC;AL V 101-00042 1-090 $92.00
•
... 161-40- 4`20 M Sty„i.'9g
E i C11403AT, t°"tM,% :
fi't:(f!';fiNNO FFES 1014WO-419-000 $167.125
S'.4"RONC} MOTION (Rtl) $20.44
G4ILAIV40 " IUIt 400.423-000 $24.00
'11v IR ASTUCI E:1 = ' . 225-000-W3-342 3-342 $4. 526.64
.ARTINPIYS U C'P4.Aw`�S Ote 3) -701-000.251000
:`t�NS' CT 11.1GIN_!�i� P).r'i.>� CHECK
:m DESS PRE -P UID
'Tf.D!CAL V:IE+ RM,*fT.FE 1,?,$ '0UE' 0W
$6,454.05 '
`tir TIN
�
CA
RECElov' y i
DATE
BY '
DATE FINALED
INSPECTOR.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR '
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
7Underground
Ducts
Forms & Footings
Ducts
Slab 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 D
BLOCKWALL APPROVALS
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 APP OVALS
Gas Test
Electric Final
Waste Lines
/0
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection .
Pool Cover
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:
C~ /
WCertificate 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: 56-595 JACK NICKLAUS BLVD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: - 9701-007
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
3/1997 15:11 714-978-9926 VCA E�IGINEERS PAGE 132
VANDORPE CHOU ASSOCIATES, INC.
CONSULTING ENGINEERS
��
295 N. Rampart Street, Suite A
Orange, CA 92868
Tel: (714) 978-9780 Fax (714) 978-9926
x
Attn.: Kim Fincher
KSL
56140 PGA Blvd. -
La Quinta, CA 92253
Subject: The Ryder Collection
PGA West, La Quinta
'Lot 15; Plan 3B
Lot 16, Plan 2B
Lot 17, Plan 3A
Since 1979:
Facility Planners
Code Consultants
Structural Engineers
Fire Protection Engineers
June 19, 1997
Dear Kim, .
In accordance with your request we visited the jobsite on June 10, 1997 and June 18, 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 18, 1997.
If you have any questions, contact Benjamin Herbst of our office.
Very truly yours,
VANDORPE CHOU ASSOCIATES:
Q�pFESsli
UNOy,c�9��y
C, yn
Robert Chou, S.E. w oao No. S 003518 x m
d EV. 3.31-W C:
AB * s
P
V�' �UCTUP �
c: Paul Dooley '9r�
fAjobMea1095\cypI l26\tield20.1&?d OF CAO '
i
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE RUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB OWN
'WAS- L A p� LA� 111
REGISTER NUMBER
REPORT SEQUENCE N0.
TYP F l}�T USRE
PERMIT NO.`/•.,G)
D YE� -��
DAY OF WEEK
MATER
L DESCRIPTION
ARCHITECT
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS .I
HRS. CHARGED
INSPECTION
DATE
GENERALSUB
CONTRACTOR (l,/. -moi CONTRACTOR ,� ,
0 � S C._. _ 0 I ,
cut -Lo
4-21
s " K I (
(�
► Tb lP Co00ec-r ('0 -t'A
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d
--
ed ( v E Z
v '"-I '\ N
COPY SENT TO CLIENT
TNTI 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.
�� C/1 I
G�IURE OF REGISTERWI
S�TORDATE
OF REPO-RRDATE OF REPORT �/��-
REGISTER NUMBER