0204-191 (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
777699 B
�' 4l4iOlG2
Signature of Contractor
_ .111 t,.• __ __
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). f
:.( ) 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
Ap rformance of the work for which this permit is issued:
;)t I have and will .maintain workers' compensation: insurance, as required by
Sec'on 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 ,. P.NC1FIf,: 3MP1_0YFS,' Policy No. WlXC43084,51 J
(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'af Section 3700 of the Labor
Code, 1"shall fort� wit comply with those/pr.
�sio s:
fr Date: � I Applicant ! ,!
Warningt 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 representat' s of this City to enter upon
the above-mentioned property for inspection' ur oses.
r'
Signature (Owner/Agent) ?!'Pa D e' .
OV f
BUILDING .PERMIT PERMIT#
DATE , VALUATION LOT TRACT
JOB SITE
ADDRESS �R.-�"t-"i1[�rTft.4�7''.�7 .t APN 04M
OWNER
OWNER CONTRACTOR / DESIGNER / ENGINEER
`MI� �(-�.pBROU.M. rIG13
y MCI.TOZLa.t
74413 dglViqY UQyE, SA4"2
!
�SF°'3 hl �dr.N..:� .A.1t919tr�k �,�ii.i6ir,d't".�•!uV
Pd1T:M M12.'T` CA. VIA"t'.:M :%F,aa�' IXf " CAI 922,60
CM -0.3832
3:32
USE OF PERMIT
9JNG1 X v wn.`C DWMXWG
SFO I,OT 3?, VENT NA PLAN. PERMIT DOda NOT INCi,YlDE 31X )CK
W. ,AL % I;CC 4 SPA OR DRIVEWAY APPROACH,
CUISTOM CfiAISTRUC"•T16H 4,�M.00 Sig • .
I?ORCHIPATIO s 14.00 .174F
GARAMYCARPORT 106.00 3N
USIMAM, , .ioy M, 1:rVJNF:@R.A.6iJ'Iv.►.101
.361, 4LJ.r D
PEEMM YEN W.i!QW"`I
CONS T lit'ff:` 10YI FEE 101-iOM418.000 SY,;1Sti.S0
PLAN CHYf:C:K; FES 101-000.439-318 $I,74ii.43
1V11:+~HANICAL.FEE 101.OM421-000 SiR0,0R
�' FX.'TRYC°.,AAL ME 101-.000-420-000
PL1 MT111NC ng 101 -000419-000 S1g4.30
S°Fk2GYno NiOTI.ON II'%LT - RESID 101-000-241-000 $36.14
GRADINQ FZ9 101-000.423a000 $20,00
I3 MOPER IRtIP.ACT YZE: $1,907.00
R?" 1N PUi3LIC. PL ACTS , RNIE 2W.i.OW- 45.000
1E�U a�T(Yl Ct�i3` RE7J l` A1 PIAN C�}� t"1:
ts,c;13.82
.
LFS Y PFEES
$0.00
TOTAL PEI IMSMM I VW'
'UM Mf
.2
'1673A
3.
ECEIPT
DATE,, l �y v,
BY
DATE TINA D�
I PCT R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
.INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
j A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
FramingCompressor
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
BLOCKWALL APPROVALS
Final
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
7
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plastee
Sewer Lateral
Pool Cover
Sewer Connection
��l
Encapsulation
Gas Piping
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 a
Final
Utility Notice (Perm)
it
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12/31/2013 05:40 FAX
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INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative'Code, Title 24,:State of California, in the building located at:
-0-e-iv—e,—Lot 37, The Vistas at PGA West Rancho Mirag"s, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-30
WALLS:
TYPE:BATTS MANUFACTURER: Certainteed Thickness: R-19
GENERAL CONTRACTOR: TOLL BROTHERS, INC. LICENSE #_
BY: TITLE:
wi UUZ
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 2/25/2003
t.
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, TWe;24, State of California, in the building located at:
VOID
CEILINGS:
TYPE: BLOW MANUFACTURER; CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: VOID y LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE- ADMINISTRATIVE ASSISTANT DATE- 2/25/2003
®11 r®t�i�rs� Inc®
(duality Homes byDesign°
August S, 2001
City of La Quinta
Building & Safety Department .
P.O. Box 1504
La Quinta, CA 92253
Fax: 777.7011 -
• ,•4' r
• h
Re: Lot # 2—
;Project: i tas Tract # 29349-1) -or- Reserve (Tract #29348-2) (circle one)
To Whom It May Concern:
This letter serves to advise you the O'Hagin roof vents have been inspected by the Toll Brothers'.
representative. The vents are as per plan to our satisfaction.
Should you require any further information, please let us know. ,
Sincerely,
Andy Fraser
Project Manager
Toll Brothers @ PGA West `
74-923 Hovley Lane East, Suite 2-220 Palm Desert, CA 92260
760-674-9699 Fax 760-674-9081
A Miller & Sons
Al miller &Saul ltc�atiliP
� �� InC
68-160 Sumjnit Dr. Phone: 760/346-121.4
c:atbedra`. C:i1Y, Ca 92234 F x: 760/321-7097
Facsimile
rfix %�try /y((( roll Bmthet s PGA West
Fax: 777-1.596
From. Russ Diller
Gate: 2-12 Y 1 ro S
Re: Inspection 23'?
Rages:.
Gary / Andy9
We have inspected all the Roofs at PGA West (Vistas and
Reserve). All vents are installed per the G'Hagin
specifications and per your plans
"hank you,
Russ Miller
LA QUINTA
ETY DEPARTMENT
TION REdUEST LINE
777-7153
BROTHERS
Owner
Contractor^ CAI,XTURI�I�A POOLS &
Permit NL.mber
0210-.030
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
81-545 TIBURON DRIVE
JOB ADDRESS
POCL, SPA, BBQ (ANSI Z21-58-1995),3 L.F. 5' BLOCK
WAIL, CITY STANDARD. ALARMS/BARRXER.S SHALL )IR
IN 1? LACE AT PRP-PLASTIiR INSPECTION.
TYPE OF INSPECTION
TEMPORARY POWER .
A4L C :)NCRETE; FLAT WORK SHALL BE PLACED 4L-
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: 81-545 TIBURON DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0204-191
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: TOLL BROTHERS INC
Building Official
Address:
74-923 HOVELY LANE EAST STE 2-220
City: PALM DESERT, CA 92260
By: DANIEL P. CRAWFORD JR.
Date: 2/27/03
POST IN A CONSPICUOUS PLACE