0207-200 (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
7'!7699
Date GS (j Signature of f Contractor OWNER -BUILDER DECLARATION
I hereby affirm finder 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 con'struct 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
performance of the work for which this permit is issued.
f� )" I have and will maintain workers' compensation insurance, as required by
S tion 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 pAV11aI:: p.MpuL' yTXt, Policy No.
WR 1 $ i %et
(This section need not be completed if the permit valuation isefor $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, fl-shall;fotYt�with comply with those prtovslons';%
Date:; "a „ 1 j' Applicant r ; "i"'.
Warning:, Failure to secure Workers' Compensation coverage is unlawful.�and
shall subject an employer to criminal penalties and civil fines up to $100,000, in '
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest,and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety'
for 'a permit subject toethe conditions and restrictions set forth:.on his
application.
1. Each person upon whose behalf this application is made & each person at '
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a "result of this applicaton agrees to, & shall, indemnify
&ahold harmless the City of La Quinta, its officers, agents and, employees.
2:,Any permit issued as a result of this application becomes null and void if
Work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above inform tion is
correct. I agree to comply with all City;"nand State laws relating to the building
construction, and hereby authorize representatives of this City to enteupa
r .- ( P
the above-mentioned property for'ihs ectlon purposes.
Signature (Owner/Agent)Ji='�'^'? Date
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BUILDING PERMIT PERMIT# _.,
DATE VALUATION LOT �- TRACT
JOB SITE !ADDRESS i�.r`.�` UJ.Z0.�+ DRIVE—t
APN 'i5.7-53 .4
�f$r_
j
OWNER
CONTRACTOR DESIGNER EEN 1NEER
d0T111SROMI7 JNC
TOLL B4Og149 WC,
74-923 HOVELY LAN :EKAST SERTI-326 22.0
74-92313O11ELX":id.- IM PADT 3XIf'M420
FAIN MSEWr CA 922603
PALM ,SFW X CA 92260
(160)(31 .9699 k."BLO. 383.2
USE O�cFPERMIT
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.
SM - LO i ,7, I?IIaDIRLA S. PERMIT DOES NOT I74C1.t1;OLP BLOCK "P: A,,,1 U,�
I '
Cual"oH, C014syrgymfo m o 4, 3-1p
PORC1itPATIG 442.80.61p
GAPAXIMARPORT 752A10 9F `
07WAM Com' 010 Ct31YMIJI;;1iON
XTb,:3« 0.80
CONSTRUCTION FEE. 101.0030-418.000 $1,255:•50
1 uvw ClIs r FSV a
I3'i1�C14A�tIC,°�1.. i+t�� ' `: 141i un00fi�2 a As�QO $ T 19, �b�
IV?.CT'RFC.AL FEE 101-b-00-420,000 $170.49
MUMAING FER 101.000•419.000 $16150
S'AT OXO MOTION PIZ • RAIU 101-000-241-000 $27.,M
MOW REM 101-0006423-000 $15,00
DE"LOP. R IMPPC`T Fes.'; $x,405.00
.E5M IN il"'1B?c1W PIA( ']W-. SM.270z00y445.OW 20413$
Y9 E
<'S SM—TOTAL CC3M. 'cUO'RON AWD PIM C MCK
1=21 PR a AU) FMTJ
Da ��^��y_�p_ �r�iy^�y gq�ry 7�,+yv� { y(; �y�ygp
$ 6�t' 1.6A:.I PERM ply .S .@'w.Tl'� ,.iKK°.�,S NOW
�y, �+
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SEP 2'.,,5t�IUUZ .
CITYOFIN Lp r AJ
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CE (0) F7 -
RECEIPT
DATE �
+}
BY
/ DATE A �jJ
PECTOR
� /
L�' tl
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts.
Forms & Footings
44 44Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_ _
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
Compressor /V.
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
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 APR VA S/)
Waste Lines _ _ �'jZ�—
Water Piping
Gas Test
Electric Final
Heater Final
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
3
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring 4
Fixtures
Main Service �—
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power jJ f
Final
Utility Notice (Perm)
COMMENTS:
'
dUt4. v 1 ; 16 P_a.X -
wJ 1St3'.
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INSUI_AT19N CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
i regulation, California Administrative Code, Title 24, State of California, in the building located at:
$'-600 Tiburon Drive, Reserves @ PGA West,ILot 7, La Cluinta,.Califortaia
CEILINGS:
TYPE-. BLOW MANUFACTURER: CERTAINTEEDTHtCiCNESS: R-30
WALLS:
TYPE: 6ATTS MANUFACTURER: CERTAINTEED THICKNESS- R-19
GENERAL CONTRAC7,`OR; Tal? Brothers, Inc. LICENSE #
BY: _ TITLE:
PARAG N SCHMID ALULDING PRODUCTS, A MASCO COMPANY LICENSE # 61':12072
BY: TITLE: ADMINISTRATIVE .ASSISTANT DATE: 4!30!2003
,`�� r,:L::C.�'6'.J:�r.ir.�-,r:l/iA!oA✓i.b e'v.a�..I}, .SY.O.CI. s.N. J, JiC.:CO.'t:'A'S.; lgr�i�'A!9."b:y��'T.�L:'SXYv.w%?.Y6+dd bv-.+ar!.vofi�'✓ �/4:em��i �'v�Mly. L+�. .O'Y.IO.vSe.! :�.I,
v
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INSULATION CERTIFICATE
This is to certify that insulation has beers installed in conformance with the current anergy
regulation, California Administrative Cooe, Title 24, State of California, in the building located at:
it 81-620 Tiburon Drive, Reserves PGA West, Lot 9, La Quin ta'California
8
j
r; CEILINGS:
TYPE; BLOW MANUFACTURER: CERTAINTEEp
THICKNESS: R-30
,
WALLS-.
TYPE: BATTS MANUFACTURER: CERTAINTEED . THICKNMS: R-19
' GENERAL CONTRACTOR: Tall Brothers, Inc, LICENSE
R
;. .
E3Y. TITLE:
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PARAGOq(S h41D BUILDifiIG PR0.6t !CT9 IS hAaerr*i
s BY: �-
TiTI.,E: ADMINISTRATIVE A,55ISTANT DATE: 4l3012003
2 ;
�ana.aw�u n�so:rs.>ms c.� aoJays�e.;dss�m�.rhq. p.Acv'w•:ama�iy�.srm. arR,r.,x�o�..+�'vos':.v. ipo.�r.� we.,.r.:nc.r.e.�a.*.; aea:�,, •;�+:. �... rr�.�.r s+r��-r.s�r..
r
ToR r®t ers, H ca
Quality Homes by Design®
August 8, 2001
City of La Quinta
Building & Safety Department
P.O. Box 1504
La Quinta, CA 92253
Fax: 777.7011
Re: Lot #
Project: Vistas (Tract # 29349-1) -or- eserve ract #29348-2) (circle one)
To Whom It May Concent:
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
Al Miller sons
Al Miller Sc Solis lt()olini;
.
6u-760 5uminic 17r. ` phone: 760/34f -12T.4
CatbodraT Cily. ca 9223.1 Ft X: 760/311-7097
Roofing Inc.
FWim-, 11,e
N, weq
Fa -x: 777-1.5916
From; Russ Diller
Date:
Re: Inspection
Pages:.
Gary / Andy,
We have inspected all the Roofs at PGA West (Vistas and
P 'serve), All vents are. installed per the O'Hagin
sfwcifications and per your plans
Thank YOU,
Russ Mille'.
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�- - ,- -` _ Cert�fica.te of 0-,ccu anc
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- This Certificate is. issued pursuant td -the -requirements° of -Section -109 of "the California Building
. �
certifying that, at the' time. 'of'issuance; `a this structure was . in ', corrmpliance"'�inrith _'the°.
'Code,
provisions of, the Building:,Code and the' ,various -ordin'ances of , the-t'City regulating
,&Widing
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construction and/or use ' r • µ �':'' ' .p °` i T " .� -�F ` s ' `:
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BUILDIN&ADDRESS.r81-600 TIBURON�DRIVE41
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• BuildingPermit No.. 20� 7,- ry V
0207-200
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Occupancy Group` R3_ y' Type'of Construction AVN n ` . ` . _ ;Land{Use.Zonep RL J
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Owner of Building: TOLUBROTHERS INC ;' ., ` ' ,,� Address'74-923 HOVELY LANE EAST SUITE2=220 _
�•ZIP:;PALM'DES
City,ST, ERT CA`92260 .
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B N?
y,� BILL GORDO
r� +_ , ,! rx ;{ �` r �• ., `` Date 5-22-03;
a
Building Official
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POST IN A CONSPICUOUS PLACE,Y'-
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