0111-060 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
fV Wi_. Professionals Code, and,my License is in full force and effect.
=)ch- ' License # ?• Lic. Class Exp. Date
d LO
LLI T_
t- 044301M
oZ ' Date �' 7 Signature of Contractor
co 0-
J U C) OWNER -BUILDER DECLARATION
lJJ W I hereby affirm under.—penalty—of perjury.that I am exempt from the Contractor's
~ fl 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).
( ) . 1, 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
LO
C\1 Date s v... '.r r � Signature of Owner
rn
WORKER'S COMPENSATION DECLARATION
CL
C) Q Z Z I hereby affirm under penalty oftperjury one of'the following declarations -
Cc
1.- 0 (.) 1 have and will maihtain.a certificate of consent to self -insure for workers'
X W u- compensation, as provided for by'Section 3700 of the Labor Code, for the
0 _J.
performance of, the work for which this permit is issued.
Q U �, I -have and will maintain workers' compensation insurance, as required by
p U Q S ction 3700 of the Labor Code, for the performance of the work for which this
6 F- permit is issued. My workers' compensation insurance carrier & policy no. are:
0Cartier ier Policy No.
ao PACIFIC EMPLOY=; T,VLR CAM4318
0
(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
3 .-subject to the workers' compensation •provisions of Section 3700 of the Labor
Code, I shall, forthwith comply with those prow pions.
/ Date: 13 ApplicanttJ !
o 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 46 the cost of,compensation, damages as provided for in Section 37063
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.
t'
1. Each person upon whose behalf this application is made & each pe'rsorrat•
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
work, is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellatio
L ` I certify that I have read this application and state that the above information s
• correct: I agree to comply with all City, and State laws relating to the buildi g
coristruction, and, hereby.autho.
edrize'representatives of this City to entercu
the above-mentionproperty/for inspecRion purposes. sir
Signature (Owns
r/Agent)•""�' 'f Date'-------=-
4,
ate
BUILDING PERMIT PERMIT#
DATE r )1 VALUATION LOT Q�t-I� TRACT
29348-2
JOB SITE Q`"
ADDRESS 814M KO 1 RY-W
APN
76I`452 -0-'0.l2
OWNER
CONTRACTOR/DESIGNER/ENGINEER
74-521110ME MMM, EAVr MUM-=
74.923OVO. s' 1: B OT 01122.2,20
PX M DEURT CA. 92-260
PALM >;3E:^ Qk 922&0
(7150-14-9699 CB -1.6 3832
USE OF PERMIT
SM- -1.:d' T 204 SANTA. UOSA A. PIFRMIT I)ORS 140-- 1WC1.U'DY,S1=k
WALTZ, i'C70MPA OR aDRIV E AY APPRC)AC H
C'€kS'I'f3M WHSTRGF0710114 OF
PORf.;3.1WA` IO 324.00 SY
C i4S3i§:GMAitPC"RT 17156.06 SF
EIRIM IT -D COSTOF OF C>o1.°q' I3,+'�C.'' C�1,i
310,560.70 '•
PIRKIT FEE SUMMARY
Gr3aiO'iRliM10H PU 101l W-418a%V $1^90
PLAN CHFXIK r1fy: 101-000-439••:118 $1,094.79
i+ YCHNNICAL FF9 1101-Q00-421-000
ZU?I'F'S; CAL n?X, 101-000-420-000
PLUMOM0 AM 101-000419-000 $160.W
STRDWO ME'1'I'•ION FEE,. RWID- 101-000-241 � WID $31.06
ORADINO FEE 101-000-423-000 8243"60
i5SVPWPER IMPACT JIM 5,1,907.00
ART RR Pt.111LIC PIAL ES RESK 2' O.000.445-000 M08
�.�•� q•�, rRr•�, �q y •�.�.��ppEf AND � t• ,, 7� •i /e �w �yq,�n,Y,o.
'.�,..• iJ�+.S:"Ai.Y�.f'�d`�A�,���bfJ[V A.ts�.R.l�,✓i..5.L1..+.i'aIJMIND ty.1„�t'4C��e,r.Y]S�.r1.r.l,�I..
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Ti7CAL FIX MIT US DUR, NOW
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RECEIPT -� "
•DATE
BY
DATE FI ALE
INSP OR
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
'Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck�/
O.K. to Wrap _
Framing �� py
Insulation
_
/��d2 (G/�/
�� DAY /�jL
_
Of _
Gf �� - ��
_�y
�7lvv
Underground Ducts
Ducts
Retum Air
Combustion Air
Exhaust Fans
F.A.U.
: Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O. _
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
�
I ( U0:5
_
Final ��(q a
BLOCKWALL APPROVAL '
Final
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
_
Waste Lines /�/���1 6
Gas Test
Electric Final
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
COIF dMEN
I �
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 Eh
Utility Notice (Perm) _)? ��" /
+ 06/20/2013 2.2:14 FAX �• `: _ t 0002
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INSULATION CERTIFICATE i h
•
This is to cer lfy that insulation has been installed in Conformance with the current energy
<' regulation, California Administrative Code. Tdle`24, State of Califomia, in the building at
--8- 50 Tiburon; L 202, The; Vistas/PGA West, -La Quinta, California
,.
CEILINGS'
�7YPE: BLOW• ' MANUFACTURER: Certainteed THICKNESS: R-38
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WALLS: 'X _ ' • ? ' �
TYPE: .BATTS . MANUFACTURER: Certainteed "THICKNESS: R-21
=
GENERAL CONTRACTOR: TOLL BROTHERS, INC.. LICENSE#:
BY y TITLE, #
PARAGON SCHMID BUILDING PRODUCTS, a MASCO Company ' LICENSE #221517
' r
BY: TITLE: ADMlNISTRATlVE ASSISTANT. DATE: 8/16102
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vwryr.^.:.fa +r....:..' -04.OW;.:f'iiw�c•��ww�ranns.rrrrri .rio�.n..avrr.�+;.avassnarms_Tera:►�rr oy�.evr of 's R'cos.�. .
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,. rvtisi�sis�n»»»mseriirw.w.riii:i.►.+�•n+.r%.crrr+e:rvv,.xisD:sor+msrm.•rir�arsi.csarrva1
e!uw►sror�+" _ -- - a
INSULATION
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 buitding.locsted at
010
' °`
CEILING � '; . • `.. - • .' . 4
TYPE BLOW MANUFACTURER: C"inteed THICKNESS: R-
`, .
." ..
`
WALLS: s
TYPE: BATTS 1 MANUFACTURER Certainteed '' THICKNESS: R-
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LICENSE #
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GENERAL CONTRACTOR:
« ♦
BY: TITLE-'
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PARAGON SCHMID BUILDING PRODUCTS,'a MASCO Company LICENSE #
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9
BY: -TITIE: ADMINISTRATIVE ASSISTANT DATE: 8116/02
I
Al miter&Soni
At Mitler & Sons jjt)Q(-jjjg
Roofing incN 64-760 Sununu ter. Phone: 760/14(,,-121.4.
y, Ca 92231 tx., 760/321-7097
Faaimik-
Qctry / Andy@1611 Bmt1jets, pC-wA West
Fax: 777-1.5%,
From: Rus'§�Ullgr
Date
Re., lnspe-(tj
Pages:
Gary 4 Andy,
Wehave inspecI'.`c."fd-! a
all the Roofs at PGA West {Vistas and
k 4
Reserve), All -v"e"nts,'--are. installed per the O!Hagin
Spec.ifications and per your plans
Thank you, -
'J 1
Russ Miller
lull AL)Tutners, ,mc.
Quality Homes by Design'
august 8, 2001
City of La Quinia
Building & Safety Department
P.O. Boz ID -04
La Quinta, CA 92253
Fax: 777.7011
Re: Lot #��
Project. Vistas Tract.# 293'49-1) -or- Reserve (Tract #29348-2) (circle one)
To Whom It May Concern:
This tenter 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.
Shoutd you.require any further information, please let us know.
Sincerely,
V;4,
Andv Fraser
Project Manager
Toll Brothers,@. PGA West
71Ioviey Lanz East. SUitz 2-22 —
_ -923 H 0 Palm. D2Scfi. CA 92?00
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: 81-550 TIBURON DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 011.1-060
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., 92253
By: DANIEL P. CRAWFORD JR.
Date: 8/19/02 .
POST IN A CONSPICUOUS PLACE