9701-009 (SFD)I' 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
M
547732is ? d�i1:>it
Date `r Signature of Contractortv.
I` _ �_
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.
K) 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 ry7 t [ �F l + ` Policy No. tib. c t . f
I t2f IC- 11 A.�V.�C.t.. MV.. -.W q�Y.[7?rPi.�lej )05
(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 37bO.of the Labor
6ate:
ode„I s all forthwith comply with those provisions.i19_-1 / `� % Applicant
y #
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
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
the above-mentioned property for inspection,purpo/s.f '
/Signature (Owner/Agent)`- `�' Date+`
BPERMT# ' . °°NTR°`#
BUILDING PERMIT g7�►�.�� 4 86
DATE5/2_7/77 VALUATION LOT' TRACT
283-10 -1
JOB SITE �+ �}��
ADDRESS 56-535 JACftp l�yt.�1.LA1 i�% �iOUL101*, RD
APN
741-.5..50-01.9
OWNER
CONTRACTOR / DESIGNER / ENGINEER
K 1, LAND J;
KSL DEVELOPMENT CORP.
w -.l 40.T)G11 R,b'.U..asps
.i)GA RO LEVAki)
1',A. t3i ltrI'A CA 92251
IA QUfN-,f'A CA. 9025;
(760Yl'/'f-364” CBL`f
USE OF PERMIT
fLf�N Cl%I4 .i; l t R�tW "F�1 t�l3t'L riUlr11P1.?a.iSS1Jf OFANi ;P AN
L"st4l: CON,? i2:tJC i l:Gi�i x,450.0% S�"
NC�'fll;l�/1�E� 9 �L"A 'sf✓!S.Cl�3 ak
Griftf1t#F.`CARO RT S21,00 SIF
1
- b4f+ .d Of"COAieT-�•X.\�f.J4,.��S�W1N
.fie{.
2044442,70
i 8'y ,g r� yy ,�• 'ySLS.��d).1'N,pA./+,[yD
MAN C'H :FIRE 101 -WO -4397318 s�2t�Sa
CONSTRUCTION M., 101000-A18-000 $1,Nnoo
2.1,000 tk�
MEM ANIC'A1 ,1= 101-000-42.1,000
to.-000-r20JJ00 IS 3.7
T+:L1�a I;�iN�7.i�1^i~.S i()1»f?00-ak19�Uiitl S:tti?.2"+
;�,+vTRONG bIOTYON (M) i.$(i�.1.4)0010.�4ry1_0rt0iy�_? $+20,44
', �'l v.�.c.+il`:t�.f - - �44Y1 "`1/t!dJ"�,�.J'VfVII•A6Vy��
IMPRASTUCIVU 2255.0)-443-342 S4,15XI54
AX.r IN PLr!'33,.iC 11 AS S (RES) .701-000-V5.5-000 $261. t
t
S(''WIi) AL: C(JRS'1R C -n_ C3N ANY) PIAN CHECK -
$6,45.4,05
LE',".S PR:1 -PATI) FFIS
$0.00
F
Y .
MAR 27 1997.-.� .
ns
a
RECEIP r
1 3 s
DATE, r Ybl?' 4-�
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
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
POOLS - SPAS
BLOCKWALL
APPROVA S
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
/o
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
PEE
Gas Test
Appliances
Final
COMMENTS:
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)
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: 56-535 JACK NICKLAUS BLVD
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
vwI
Bldg. Permit No.: 9701-009
Land Use Zone- RL
Owner of Building: KSL LAND II Address: 56-140 PGA BLVD
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 10/23/97
Building Official
POST IN A CONSPICUOUS PLACE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(619) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE �RUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB1 TION / ASK gkcKIAuS LA QU t � \
REPORT SEQUENCE N0.
T'SOF�F TORE
PERMIT N0.
DA E
DAY OF WEEK
MATERIA
D , ION _/I
ARCHITECT
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS I,
HRS. CHARGED
INSPECTION GENERAL c SUB
DATE CONTRACTOR S� �.� (,J CONTRACTOR
It
L
C49t4N(?C-n b[A- TES
S H a 1p
6-1 1612 a -T- ff-6 J.t\Q je
�LI
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE ❑
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.
SIGN RE OF REGI D IN0ECT
J61p,97-Sr
DATEOF REP RT
REGISTER NUMBER
91'1997 15:'11
VCA
714-978-9926
Attn.: Kim Fincher
KSL
56140 PGA Blvd.
La Quinta, CA 92253
ICA Et IG MEERS
VANDORPE CHOU ASSOCIATES, INC.
CONSULTING ENGINEERS
295 N. Rampart Street, Suite A
Orange, CA 92868
Tel: (714) 978-9780 Fax (714) 978-9926
Subject: The Ryder Collection
PGA West, La Quinta
Lot 15, Plan 3B
Lot 16, Plan 2B
(Loi 12, P1an.3A
Dear Kim,
PAGE Ill
Since 1979:
Facility Planners
Code Consultants
Structural Engineers
Fire Protection Engineers
June 19, 1997
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:
I
Robert Chou, S.E.
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