9709-090 (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,
J� — 1i , 2r.1 j I 199
Dated -r Signature of Contracto E ►' Si' '
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.
(:) I have and will maintain workers' compensation insurance, as required by
Sec ion 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 Zr I M.
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 prow isions of Sec 'on 3700 of the Labor
,Code, I shall forthwith comply with th se,provisions..
Date: 2 42-7Applicant 11
Warning. Failure to secure Workers' Compensation coverage is unla ul 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.t6
any permit issued as a result of this applicaton agrees to, & shall, indemnify,t
& 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
t e above -mentioned -property for inspection p rposes.
....� j
Signature (Owner/Agent) •Date ''�' ✓"
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION �TA-+LOTS TRACT
SIT .al14���
APNJOB
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
36-140 FGA BIN -11
LA(r�UKT-A. (�'A. 9225A
LAQUIN A. CA l'O
MIN 4676
USE OF PERMIT
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RECEIPT t
DATE
BY `
DATE FINALED
INSPECTOR
4*
t1.
If' ,v . 1f' f y W
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade I j
Return Air
Steel
Combustion Air
Roof Deck Q
Exhaust Fans
O.K. to Wrap Jd
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 •
-1-,74-97
Dryyvall - Int. Lath..11401
D
ZVI /Y
Final
Final o
BLOCKWALL P ROVALS
POOLS - SPAS
SteeG>
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
1 11
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 727,
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) /o
ELECTRICAL APPROVALS
Temp. Power Pole .
Underground Conduit
;,Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G:F.I.
-,,Smoke Detectors
Temp.; Use of Power
;Final
.Utility Notice (Perm)
COMMENTS:
_
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: 56-660 JACK NICKLAUS
Use Classification: SFD Bldg. Permit No.: 9709-090
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
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDVOP
3580 Con glia AWS
�
Yucca Valley,c&ADREC
M,,�84� 0
(760) 365-5045. APvt;
TYPE OF
INSPECTION
PERFORMED
1
O REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY ❑ �>
❑ POST TENSIONED CONCRETE ❑ ASPHALT �Q OTHER ->
13 REINFORCED MASONRY ❑ FIRE PROOFING , `
JOB LOCATION
i
l
/C/.
REPORT SEQUENCE NO.
TYPE OF STRUCTURE I
s
PERMIT NO.
DATE
/ -6- 9 7
DAY OF WEEK
MATERIA DESCRIPTION
ARCHITECT
INSPEC R
MRS. CHARGED
ENGINEER
ASSISTANTS
HRS.CHARGED
INSPECTION
DATE
GENERAL�� SUB
CONTRACTOR i L- CONTRACTOR J
10-)5'
Cle L)EGi GlJ! Id
AAS 4!!5
I
Aha e-1294
COPY SENT TO CLIENT O
CO
MED ON NEXT PAGE O
PAGE
OF
CERTIFICA%ION OF COMPLIANCE
Ct I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST CF 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.
SIGNATURE OF REGISTERED NS ECTOR
DATE OF REPORT REGISTER NUMBER