0203-167 (SFD)`.' LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cha'oiler 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
4/M/62
Date Signature of Contractor r ), -
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 t i % ! __.• Signature` of Owner
- /k- k
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 PACIFIC EMPLOYEE Policy No. WLR C41CM318
(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 those pro"visions..
Date: t % Applicant ✓ P, ro
..? , V/ I/
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 inspecttiiooJn,p rposes. /
Si nature (Owner/A -1 A�01 P Date Wi '7
W
BUILDING PERMIT PERMT#
DATE VALUATION LOT TRACT
Jod SITE fir,
ADDRESS r-'8i1";;`� '�dbUX.ZL�,�+C�DIWZ
APN
i
fir-»'
fr
8� ..' �'••>��,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TOIJ , BROTBERS RITC
IML BROITMRS 1144
7y4-�9,23 1i,T��Ct��,rr.`itt�++]+!LY �.�:Pb'�:_ Pl�.`;T
� 74-923py�+!,,A9;�?�"1Y�PyJJ*1 I.�t EJ.4Vr �'Ce�ITIn`.E2-720
/9ViR.'i�a`f�.t�n-.�2y"2t
1�.ca�.i�..iJ-L'oW.�: R'r CA 7F4260
PALNT DES?1;f r PNC Q2260
(760)6714.9699 CTRU 3832
USE & PERMIT
IGLE IF.AANO.l D W171'U1G
SPD - LA,+' 4,'il.f NTANA RJ AN. PE.RIMIT DOES NOT INC.LO-119 i3WCK
WA1~,IA P0014 PA. OR DRJVMWA.Y API'RK)AC,H
CUSTOM L"ONSTRUC't"dO N 4,0.5,7.00 SP
I OiZCd IPA- TIO 514.00 SF
OARAGI i?ICWtP RIT 706.0 ► Sp
998zW_rArRW CONT OF Lo:.Ys.1.3.t1/c/.43.ohl
3O 6,714.10
�.Kf:dA.lUFJ.1 �f7.3L JiEf:Y �IJ3:W�L�
CCWOYS'RUCTION "Its 101-000.418.000 '$1;40:0,)
PLIAN is it WX PUE 101.••000-439-:418 $<,.166.12
MFA."HA-141C:AL FEE 101.000.421-tr00 $4+u
"I
9Lt?sa`fR.ICAL FEE 101 -000 -420 -OW
PLUMBING FEE 101.000-419.000 �A67,,49
STi3l.JNO MOTION PEE a PX310 101-0W-241-000 $33.67
inM10 i-0: 101P,000-42.3-000 920.01
IDS VILILOPER IMPACT 1110 .' $I,907.p
Afff IN :PlgBUC PLACES - RESN 270 -000445 -OND S3411
V
,mm
ffid,1.0-TO`1°AL PLAN VIrECK
$%5.,400.70
I FZS I?RE4.'
S $01001
RECEIPT
DATE
BYE
D E IN E9/IU
SP
1� _ � �r: •
i�� lllf .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
F.A.U. _
Framing /{7
Compressor _07 Tr
Insulation
Vents
Fireplace P.L.
Grills!
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath pZ
Drywall - Int. Lath
Final
Final _ -
POOLS - SPAS
BLOCKW LL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg, Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
4
Electric Final
Waste Lines
Heater Final
Water Piping i. G�.�j
Plumbing Final
_ _
Plumbing Top Out —�/
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Pool Cover
Sewer Connection 11i�
Encapsulation
Gas Piping
Gas Test /�/Q�01
Appliances
Final
COMMENTS:
Final
_
Utility Notice (Gas)
ELECTRIC l WAPPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
1'q/09i2013 U4: It$ rax
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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:
81.570 Tiburon Dive, Lot 204, T Vistas'@ PGA West, La Quints, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness. R-19
r
GENERAL CONTRACTOR: TOLL BROTHERS, INC. LICENSE #
BY. TITLE:
s
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
r
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/4/2002
sr..a. rrA:wrrrwrrssrwre, vdl./�f�N.N'I/i•XavA,Irv.nn-s�.c•r-..vTrli•vwN•.'NNIS•,'./.Nl,'/�!'iilrw'%irA!!v w"iv. A: A'/.!li is'ww..'.:.
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:
81-555 Tiburon Drive, Lot 238; The Vistas a PGA West, La Quinta, California
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
Foll'BrothersGInc.
Qc7�ility Homes by Designs
august 8, 2001
Ciil of La QuItita
Buitding & Safety Department
P.O. Box 1504
1_a Qulnta, CA 92253
Fax: 777.7011
Re. Lot ,,_ 'zO L1
Projzct. i as Tract # 29349-1) -or- Reserve (Tract #29318-2) (circle one)
To Whorl It May Concern:
.This lerter 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.
Andy Fraser
Project Manager
Tull Brothers @ PGA West
74-923 Hovley lane C -est Suite 2-220 Palm Desert. CA 92^6330
mmer &
Soni
Al 1vliUcr & Sons Hoofing
"
" oo n inc. ;Ca I�/ Sununit 11r. hhOhe: 760/3 ]6 1Z1.4
g(athcdral C.ily, C a 4223,1 Fwx 760/321-7097
Fm-
i1e.
r�'(1C GCtry my@1011 Bruthms PGYA West
77'7-:1.596►
Froni: Russ' Miller
Date:
Re: i n pe'cti;Q`n' 20 q . v/67
Pages::
Gary / Andy,
We have inspected all ,the R®ots at PGA West (Vistas and
Deserve). All ..vents,', are installed per the Q'Hagin r
specifications anus. per'your plans
i
Thank you,
Russ, Miller