9709-094 (SFD)IN
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,
734493 ii "_
Date 44 & Signature of Contractor/--
OWNER-BUILDER
ontractorOWNER-BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(%p I have and Will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the perrorrnanue of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier��qq pptt,ijj 4 ra +i< 'CO,
Policy No. 6yy rr.� .,w Ps ►4>
(This section need not be completed it 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
/Ze:
bject to the workers' compensation provisions of Sectio, 3700 of the Labor
de, I.shall fortwith comply with those.provi 'on � Applicant 1. 7�
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
& 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, c
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
Ste above- mentionedIroperty for inspection'pu%%rposes.
ignature (Owner/Agent). ± is ate
/fit J
PERMIT# CONTROL#
BUILDING PERMIT '�7`���'����
5 d (9
DATE VALUATION ..,S'Z�i0Jt11-'90 LOT '10 TRACT 2S4 4
JOB SIT36-780 JACK INiCiiA,AUS
APN %y9—'S!% .046
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
S,
CORP
56,1,t IK;I ,. ilLVD.
XNVZV.#`u.11 tjL vii
I.A. t3UxN"i.'.a1. iCA 945_4
LA QU[NTA C'.t'l e42253
MIA' 4676
USE OF PERMIT
S'k'i - RVi,.� ,7R, t' AN UM 40. PLM4 x;.145.." f.' YWI_EiJR OF .jtT,.U5
iti-L:rTIM)13Y 75%F i'QR.tViUJ.'r1PLL: ZS PiF OF SAW J4. AN h.*,
.x. r-111 ", . f.
TION 21,379.0 ;T
• ;{°,a81"O't ti��fi .��d gl ('���'i' g'�.'f1 ����} (y 1'I'�". 'S. Ai
i.St1d'�l.�i,. KI'�d,r>.e1:s 5E '4d'R' e.iit:aa:i'�OR�J7+*�i.�t!
'#!�1 !D`Q (�3
Ga1'Vt�a✓A.JV
�f.�g7{y' ]�,,.g�J�,e.v.
y� �y ,g ����eME
.�,%'t9S,7R1l..t R, 3!��'r 9'/,g1��7eo1)',t.�!aRY
E t find y"T ii t"iC3%� `+ 1,01,M-418-000 99.t 06
,�G'`LL"iilk�+eL;}\Xr,n�a'4i.. ,t 4.+'i��vV*,4�.�.•�tl _ +��3.�t�'
PUfN'{ 1040 nip, 10-14K O4194A
104 (}(fftr 4�i-tt(}E) �' f1 �►
�a"R"NO4NO 1T1"sf. fOt-000.413 i}W wC .Cte!
ioUsInut: 4JR'sn t� 123-0004�.,1-'142 $4,444,09
ART1N PIJBIAC PLANS"Cw'i;i1(tCl-2�rg�;< Ot! S » z3,4t►
c1f iN 'RUC"S',*fit .AND ��1,A CFMC4,
� v4m tz3
,WA,
^, I. S9 Pf4!:-PA1D FEE
9� >M
?I 6199 TOTAL AL PER:NIff F:E1N :€3eJ.C.'NOW
$6,356.0
9,
P
is `
.
RECEIPT
DATE
BY
DATE FINALED-
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
1A
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
(o 1_5pf
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
DryAyall- Int. Lath
'
OWL
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 Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
.17
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
Encapsulation
Gas Piping
Gas Test -
/O
Appliances
Final
Final
Utility Notice (Gas)
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 -5-
City
City of La Quinta.
Building and Safety Department ofnE
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:
Use Classification: SFD
Occupancy Group: R 1
Owner of Building: KSL LAND II
56-780 JACK NICKLAUS
Type of Construction
Building Official
VN
Bldg. Permit No.: 9709-094
Land Use Zone: RL
Address: 56-140 PGA BLVD.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL- _
Date: 4-14-98
POST IN A CONSPICUOUS PLACE
CITY OF I -A 001NTA
r
NOV 12 REC°® JON TANDY
EUILDING ANL) .c�rd, , 580 Condalia Ave.
FYryu'cca Valley, CA 92284
(760) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
1
❑ REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
)(STRUCT. STEEL ASSEMBLY
❑ ASPHALT
❑ FIRE PROOFING
❑ 13
1 OTHER
fRJ g—'m 1 fv,
JOB LOCATION
O
I
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
PERMIT NO.
DATE
/-,6 - 7
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPECTOR
HRS. CHARGED
%
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL ��
CONTRACTOR (��!i
SUB P ` Ar
CONTRACTORJ (,,(f �J 'Y
tt
Ji
i
5' Lsx 0 X-'/
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COPY SENT TO CLIENT
ceoINUED ON NEXT PAGE ❑
PAGE
1,.
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.
��
SIGNATURE OF REGISTEREI SPECTOR
DATE OF REPORT REGISTER NUMBER