9709-089 (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
, )r
Date � Signature of Contractor t''"�Ql �U ^� `-� f `
U
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.
,,(y) 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.
E: I INS,tag. we r±SMOOS
(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,s �fort comply with those pr vlsi t
Date: + b �" I Applicant r91
Warning: Failure to secure Workers' Compensation coverage is 'nlawful 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 is
correct. I agree to comply with all City, and State laws relating to the building
cphstruction, and hereby authorize representatives of this City to enter upon
the above- mentioned-property`for inspectio)rn urposes.
%
!-f ! Dates
Si nature (Owner/A
PERMIT# CONTROL#
BUILDING PERMIT 974'01-#.X(� 5 9 3 7
DATE ^ � VALUATION ;Rj2f;�,�.442,7{) LOT, , Z4 TRACT ;�;;i^j
A
ADDRESS .78Y9i9.4�i xiill� :�,,irlfeJOB SITE S
APN
OWNER
CONTRACTOR / DESIGNER[/ ENGINEER
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LA. (X1f6rVA CA 92253
LA(,�ATA CA. 0253
USE OF PERMIT '
5s :tr - W D , i L.Ait4 i,{DT 35, PLAN Oi.?:h' K PCWHON 01' lr EMSS
J S`,U i 01: SAME KA N `3'YJAi.
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S6.04AS
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RECEIPT
y`
DATE
1.
BY
DATE FINALED
INSPECTOR
Y
I'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS Af
MECHANICAL APPROVALS
Set Backs
zdz& I I e
Underground Ducts
Forms & Footings
Ducts
Slab Grade
41Return
Air
Steel
Lr
Combustion Air
Roof Deck
ZZ 7
Exhaust Fans
O.K. to Wrap
917
F.A.U.
Framing
Compressor
Insulation
IL
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
.S77 9,f-
O
Final
Final
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 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 n 73
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
"
Appliances
Final
Final
Utility Notice (Gas) o Q
ELECTRICAL A PROVALS
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:
..0
Certificate of Occupancy �i, .
City of La Quintal
Building and Safety Department OFTM
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: 56-630 JACK NICKLAUS
Use Classification: SFD Bldg. Permit No.: 9709-089
Occupancy Group: R 1 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: STEVE TRAXEL
Date: 4=10-98
POST IN.A CONSPICUOUS PLACE
4
REGISTERED INSPECTOR'S WEEKLY REPORT
r' cirl
JON TANDYop
3580 Condalia AvV 12 R fCp
Yucca Valley,A.Bg;�S4
(760) 365-5045 '��� SA':. -&7y
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE )KSTRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑ S O
OTHER �!
W f, /Q// 4
JOB LOCATION ,_.�_6� /a
-\�1��
` ^ 'Z'
REPORT SEQUENCE NO.
TYPE OF STRUCTURE p
dEb//W�
PERMIT NO.
DATE
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL
DATE CONTRACTOR
SUB
CONTRACTOR
/
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COPY SENT TO CLIENT
O INUED ON NEXT PAGE O
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.
wv`
SIGNATURE OF REGISTyfiEDI
INSPECTOR
- 9 -7
go e
DATE OF REPORT
REGISTER NUMBER