9805-029 (AR)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
ci � Professionals Code, and my License is in full force and effect.
C) License # Lic. Class Exp. Date
0 734283 B 3131%94
I Z r- ate Signature of Contractor — trr /moo""""-�
�O�
J U C:) OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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).
C'`) () I am exempt under Section , B&P.C. for this reason
LO
O N Date Signature of Owner
rn
d< WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U �� ( ) I have and will maintain workers' compensation insurance, as required by
O ULO Q -- Se�tion 3700 of the Labor Code, for the performance of the work for which this
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
ob
(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
worke Pcompensation laws of California, and agree that if I should become
3 subject to the workers' compensation provisions of Section 3700 of the Labor
C • de, I shall forthwith comply with those provision,,,,-•-
�s.
te: Applicant 1A v- � •a
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
7above-mentioned property for inspection purposes.
,/Signature (Owner/Agent) '.- f/ AA& a ..- %` Date - 0 -
BUILDING PERMIT PERMIT#
� CONTROLJ/
9X001-111129
DATE VALUATION S33.964.40 LOT 1 q
TRACT 7k,712 0
JOB SITE
ADDRESS 90-297 RIVIERAAPN
761-48(M) 31
OWNER
CONTRACTOR/DESIGNER/ENGINEER
XSL LAND H)
KSL DE .'EL,CIPMEIII*CORP
5592011GA BLVD
_56-140 PGYA Ri,.VD
LA i,?UItTrA CA 192253
LAQOTNI'A
CA 92
(760)564-71 W
C B IA 4670
USE OF PERMIT
:Silf=lt1,Ef',fS N ':3i 'l u P..lrltbHT 99*J_ 021. LOT f.9. ADDING G2 1A.3r
H011.1:�F TO ftI,Rf7'Atfi PLAN 2A UI�fVIIR CONS l'htllC1 100.
PA
_'ITY
F LA QUINT,
i
CUSTIMIXI'VED CM1711, 0`1 CONSTRUCTION
33.9(4.)
C:i_aNtit'ftllC'1'ION F -EL (i.;i_c1t?f1 iIK-(XK) 3119.00
Pr. 0; r"} ITCK FRP 101 -MI -41st -14 R i Y* si
rfCCf=ICTAL VM �� Ct�tl.i�f.•1JflU a
E1, CM,fc� XL FE1- #Oe-f>C10 =12 -OUB SiS.:a
11LUMBINO ME 101 -OW -419 -WO S�3tJ.l� t
vi,RS ,,wn kir*,rir1N rS.Iz p1:Cf}? 1(11-fIC}l! ^df-ilfi(i !s3 c1
61tA:]IN, 1111, �Q� -0OJ ;i23 000
11'iN:�N�f'.t'1.t11Q"i'U��:l'l:� �2�-lNi1J-+�#3:•i�l.�. �fitil.;�i
AfCr 1N PIMILIC,' PLACEN - Rti811; 701 -OW-2155-OW 8$4.9t
:�{.1j;-aiY!if11.l.Cf?V ,?[tt3f~TONAN€1 MAN CHUCK
11.017 I t
L E SS 1'R U -P. SIL? FEES 1000
'UOTAII, 1yl+;RM1T irY1+.S DUE NOW
S .,t1.t7,I3
RECEIPT
DATE
BY -
DATE FINALED
INSPECTOR
-- IG / V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_ ((o —
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—
Drywall - Int. Lath
— K -
Final
Final /--2 —
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
�o _ a 7
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final _
Utility Notice (Perm)
COMMENTS:
��... Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext: 235
M
This Buz For Distrlct Ilse Only
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: PGA West - THE HERITYAGE COLLECTION Date: May 11, 1998
Owner's Name: KSL Development Corporation Phone No. 760 564-7166
Address: 79-993 Ri veri a , La Qu i nta CA 92253
Project Description: , Addition to existing home under::constructi on
APN: 761-480-031,
Tract #:
Lot #: 19
Type of Development: Residential XX Commercial Industrial
Total Square Feet of Building Area: ;`$ "_?'; 436
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/she is autorh* o..sipAi behalf of the owner/developer.
Dated: May 11, 1998
Si
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE):
Gov. Code Gov. Code Project
53080/65995 65970 Approval
Number of Sq./Ft.' '4-
Amount per Sq/Ft. $ -0-
Amount Collected $ -0-
Agreement Existing Not subject to fee
prior to 1/1/87 requirement.
Note: Fees already paid at $9.000 dollars
Mitigation Fees on March 18, 1998
By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services'
Administrator in Charge
Certificate issued by: Vi vi ana A. Martinez Signature:
1CMCE: Section 66020 of Ute Govenunent Code enacted as Assembly Bill 3081, set fortli as Chapter 549, Statutes of the State of Califontia,1996 effective Jam 1, 1997, requires that thtis school district provide a written notice to
lie project applicant at the tune of payment of school fees, ntitigation payment or other exactions. This notice is to advise you tat any protest iu regard to such muomms or the validity thereof bt accordance with Section 66020
f the Govenuiit Code and other applicable law, cormnences with such payment or performance of arty otter requirement as described in Section 60020 of the Govenunett Code. Additionally, this notice advises that the
rotest thereof mmtst occur widfut 90 calatdar days thereafter.
Note: AB 2926 and SB 201 fees are capped at $1.84 per square foot for all residential construction, and at $0.30
per square foot for commercial/industrial projects.
Dev. Fees Disk: Misc\Cert-Com.Sam. (REV. 1/97)
DEVELOPER FEES PAID
AREA:
QQ
AMOUNT: $
RCPTJi:
CK #:
C'.A.SH:
INITIALS:
DATE:
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: PGA West - THE HERITYAGE COLLECTION Date: May 11, 1998
Owner's Name: KSL Development Corporation Phone No. 760 564-7166
Address: 79-993 Ri veri a , La Qu i nta CA 92253
Project Description: , Addition to existing home under::constructi on
APN: 761-480-031,
Tract #:
Lot #: 19
Type of Development: Residential XX Commercial Industrial
Total Square Feet of Building Area: ;`$ "_?'; 436
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/she is autorh* o..sipAi behalf of the owner/developer.
Dated: May 11, 1998
Si
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE):
Gov. Code Gov. Code Project
53080/65995 65970 Approval
Number of Sq./Ft.' '4-
Amount per Sq/Ft. $ -0-
Amount Collected $ -0-
Agreement Existing Not subject to fee
prior to 1/1/87 requirement.
Note: Fees already paid at $9.000 dollars
Mitigation Fees on March 18, 1998
By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services'
Administrator in Charge
Certificate issued by: Vi vi ana A. Martinez Signature:
1CMCE: Section 66020 of Ute Govenunent Code enacted as Assembly Bill 3081, set fortli as Chapter 549, Statutes of the State of Califontia,1996 effective Jam 1, 1997, requires that thtis school district provide a written notice to
lie project applicant at the tune of payment of school fees, ntitigation payment or other exactions. This notice is to advise you tat any protest iu regard to such muomms or the validity thereof bt accordance with Section 66020
f the Govenuiit Code and other applicable law, cormnences with such payment or performance of arty otter requirement as described in Section 60020 of the Govenunett Code. Additionally, this notice advises that the
rotest thereof mmtst occur widfut 90 calatdar days thereafter.
Note: AB 2926 and SB 201 fees are capped at $1.84 per square foot for all residential construction, and at $0.30
per square foot for commercial/industrial projects.
Dev. Fees Disk: Misc\Cert-Com.Sam. (REV. 1/97)
r
-98 WED 04;09 PM
1
M
KSL DEVELOPMENT CORP
0
FAX N0, 7605677131
DEVELOPMENT CORPORATION
May 6, 1998
City of La Quinta
Mr. Greg Butler
78-495 Calle Tampico
La Quinta, CA. 92254
Dear Greg,
This is a formal request to add .a G2 guest house to lot 1.9, Phase 8 Tract
28340-2. Currently the building permit & sequence sheet shows a plan 2A, it
needs to be plan 2A- G2. Please initiate the appropriate paper work to make this
change,
Should you have any questions please feel free to call.
Sincerely,
J.R. Mauro
Director of Construction
55.920 PGA Boulevard 11 La Quinta, CA 92253 • (760) 5647166 • Fax. (760) 564.7131
P. 02/05
E
City of La uinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: 1 Guest House (see attached)
PGA West, Lot 19, Tract 28340-2
Applicant Contact: Roger Hobbs, KSL Development Corp., 564-7121
ApplicationCirculation te:
Community Development Department
5/7 8 5
Date
Christine Di Iorio, Oanning Manager Date
Public Works Department
Steve Speer, Senior Engineer Date
Building and Safety Department
Mark Harold, Building and Safety Department Manager Date
Health Department
Date
Fire Department
Date
Schools Fees Paid
Date
City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: 1 Guest House (see attached)
PGA West, Lot 19, Tract.28340-2
Applicant Contact: Roger Hobbs, KSL Development Corp., 564-7121
Application /e!!5' D 7
Date
Community Development Department
Christine Di Iorio, Planning Manager
Public Works Department
Steve Speer,/S4nior Engineer
Building and Safety Department
Mark Harold, Building and Safety Department Manager
Health Department
Fire Department
Schools Fees Paid
Date
Date
Date
Date
Date j
Date
MAY-06-98 WED*04:09 PM KSI. DEVELOPMENT CORP FAX NO. 7605677131 P. 02/05
•
DEVELOPMENT CORPORATION
f
May 6, 1998
City of. La Quinta
Mr. Greg Butler
78-495 Calle Tampico
La Quinta, CA. 92254
Dear Greg,
This is a formal request to add a G2 guest house to lot 19, Phase 8 Tract
28340-2. Currently the building permit & sequence sheet shows a plan 2A, it
needs to be plan 2A- G2. Please initiate the appropriate paper work to make this
change.
Should you have any questions please feel free to call.
Sincerely,
J.R. Mauro
Director of Construction
55.920 PGA Boulevard La Quinta, CA 92253 (760) 564.7166 ' Fax (760) 5647131