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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 # Q; Lic. Class Exp. Date
yj
Date v` i Signature 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. I
`'Q 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 ��rr}!vv�� ££ �rr�11� 11/ ry Policy No. dd AA
Z4.,J.lf (,r.r.1 tNIS. ckl 1q C 6U:t311116 r•_5'
(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,
1 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' compensatio provisions of-Sectioo 3700 of the Labor
(Code, I h (f w' comply wr�lme
visions
Date: , !' ` Applicant i /
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'S
whose request and for whose benefit work is performed under or pursuant to. t
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
cstructi
oin,on, and hereby authorize representatives of this City to enter upon
,�t e above-mentioned property for inspection purp se . t
'Signature (Owner/Agent) ate
BUILDING PERMIT PERMI`#IiiK{ F} CONTRO5 7 3 l
//J/f VALUATION S�!j �T�(}rj, f� LOT 1 TRACT 0
DATE Q/I
' 5/q
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S/4iS '
ADDRESS
APN
OWNER
/DESIGNER
CONTiR'ACCT'O.
6.;1,i1 .r,*1AID3
lR�{)!E`NslG1I�N!EE'R
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ate. 1 1 f 1-. r r. •. r. a_a,. , , t !
54-1•it;l�P: ct 81...'iJ.
PGA BLVD
Clfli,ff 4676
USE OF PERMIT
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GRADING 101-W4.221.000 $20,00
ii+ ItAS•1V;ICTURE i'L43 2Iy-(fiflfl- i-��3 SEi.ut ).UEt
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$9,421.31
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a.
RECEIPT
DATE
By'.
DATE FINALED
INSPECTOR
W
1 k
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground 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 - - Q'
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines _
Party Wall Firewall
Exterior Lath Q
Drywall - Int. Lath
Final
Final 4 1
BLOCKWALL kpkOVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam a
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
Sewer Lateral
Pool Cover
Sewer Connection -/ -
Encapsulation
Gas Piping
Gas Test _
Appliances.
Final
Final
Utility Notice (Gas)
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
5: Final
Utility Notice (Perm)
COMMENTS:
L'
SPECIAL INSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045.
TYPE OF ,
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
OTHER
s"0p
JOBCATION
..
REPORT SEQUENCE NO.
TY E OF,rUC UREPERMIT
NO.
D TE
'_01a' 1
DAY OF WEEK
TERIAL DESCRIPTION
ARCHITECT
SPECTOR
``�
HRS. CHARGED
E-11 iT-
.
ENGINEER
ASSISTANTS
HRS. CHARGED
DATE
GENERAL
CONTRACTOR
SUB
. CONTRACTOR o
OQd
o •
O
nn C1\00
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
IHEREBY 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.
qSlGtiATURE f GISTERED I ECTOR
ppC)C)�r //)) w
DATE OF REPORT REGISTER NUMBER
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:
80-348 HERMITAGE
Use Classification: SFD Bldg. Permit No.: 9708-063
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: STEVE TRAXEL
Date: 6-8-98
POST INA CONSPICUOUS PLACE
RECREATION CORPORATION '
Im
November 5, 1997
Mr. Mark Harold
Building and Safety
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
Re: Fairway Homes at PGA West
Elevation changes, Heritage Phase 5
Dear Mark:
We are requesting that the following units change their elevation designation at Heritage Phase 5:
Parcel 5, Tract 28118 80 -348 -Hermitage Permit # 9708-063 `Change from 3B to 3C.
This unit has not been started due to the parcel map 28489 processing.
Parcel 14, Tract 28118 80-348 Hermitage Permit # 9708-072 Change from 3C to 3B.
This unit is framed, but has not been inspected yet.
As these are elevation changes only, I do not believe that any changes are required for fees.
Thank you for your consideration and time. Please call me if you have any questions or comments.
i rely,
Paul W. Dooley
Project Directdr
KSL Development Corp.
cc: Dan Crawford
Greg Trousdale
Marcus Fuller
Michael Wiles
Gene Darr
Roger Hobbs
Bill Dodds 1
PLD4. g (ofi
DIVISION
America's Leader In Distinctive Lifestyle and Recreation
56-140 PGA Boulevard • La Quinta, California 92253 • (619) 564-1088 • Fax (619) 564-4880