0203-209 (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
73'F iy9 /' 4130/02
%�-
Date ���¢� �^ Signature of Contractor -�%-
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).
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 r a on
Date I.g/: > 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 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 PA%,IFIC g?.v1PLCDy3r Policy No. 11094318
f 4
(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 3700 of the Labor
Code, I shall forthwith comply with th6se.p+rovisions.
Date: Applicant—
Warning:.
pplicant 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 rep(esenlatives of this City to enter upon
the above-mentioned property for irnspec lon p rposes. :.
Si nature (Owner/Agent) 74� Date e
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BUILDING PERMIT PERM T#
DATE VALUATION LOT. TRACT
29348.2
JOB SITE _�•+y�y �yy� gqq�e
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
POLL 1~SRaMj! S WC
74-923110�"3,T.IABEAMM712-11t
74- "PS HOVEL 'LAN EAMSUn= -220
PALM IYON-Wr CA. 9216C
BALM L?' SMT CA 92260
(360)674.9699 ("S6 38,47.
USE.OF PERMIT
'CSL FAtA;fLY D'lAa 'L7. MG
IT - LW1 , SA?;+ T—A P.03AA. P��f. ta�WIT f)OES 110
MW
8VOCK W-ALIA P006 01PA.t3R DRIVEWAY APPROACH
CUB -ram cb-i r.RxfC` oq 3,791,90 9F
PS1IiMPPATIO 524.00 SF
MRAMIC.t1RPOR`,i' 6.0a SF
d3M.8d7R.F!'►M COSTOP CYONSY.Hi.tF.+b, 101.6
"7.RC?yvA�7 -1c
M.Wrilms SUMMARY
CONSTRUCTION :ION FEE 101.000.4.1 SwID00 $1,378A
PL" CHEM Poll $1;094,'"$
MECHANICAL. K t, 101-000-421-000 S9811-10
HL ?CTRICAt,, FEE, 101-000-420-000 $179-16
101-000-419-00-0 S10J.0
STIZONO IV10'T1014 FEK - I;19D 102.000-241.01M. of
6
OMMO PP -19 101-000-423-000 3201(0
DEVELOPA0, IMPAXT FEE 1,90m
0
AtWf .11t PUBLIC PLACES RE31L 270-000-445-:000
8
nw
SM-'1M'AL C(gHfi, .RLTC11C3N AMVLAW C: EC K
$5,10.29
1 =1 M -PAM PHO
3 $0.00
APR 12 20 2
RECEIPT..,
DATE t`
Bl
DATE F AII
INSPECTOR��
ag
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
j
F.A.U.
Framing
—
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O. '
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z prt_
Drywall - Int. Lath
21 Z
Final
Final 3
BLOCKWAL 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
Sewer Connection
`�Z
Pool over
Encapsulation
Gas Piping
Gas Test
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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:
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INSULATION CERTIFICATE
This is to certify that insulation'has been installed in conformance with the current energy
r
regulation, California Administrative Code, Title 24. State of California, in the building located at:
_ . 81,555. T_iburon,Drive,-Lot 236, The Vistas is PGA West, La Quinta, California
x
CEILINGS:. ,
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-19
GENERAL CONTRACTOR: TOLL BROTHERS, INC. LICENSE #
BY.
TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/4/2002
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Certificatef
o Occupancy acs.
.W
City- of La' uinta -
Q
Building Yand Safefy'Departmeht`oti
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: 81-555 TIBURON DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-209
Occupancy Group: R-3, , Type of Construction: VN Land Use Zone: RL
Owner of Building: TOLL BROTHERS INC f -Address: 74-923 HOVELY LANE EAST SUITE 2=220
' City: PALM DESERT, CA!92260-
By: STEVE TRAXEL 3
Date: 1/15/03
Building Official;
POST IN A CONSPICUOUS PLACE