0204-082 (SFD)LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of
F --P Chapter 9 (commencing with Section,7000) of Division 3 of the Business and
04
w Professionals Code, and my License is in full force and effect.
O = M License # Lic. Class Exp. Date
ULO
U 777699 B 04/30/21C
Z / Date!T? , Signature of Contractor
J U ✓ OWNER -BUILDER DECLARATION;'
HUd I hereby affirm under penalty of perjury that I amrexempt from -the Contractor's
U) 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 isnot intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am. exclusively, contracting with licerised3
contractors to. construct •the project (Sec. 7044, Business & 'Professionals
Code).
O I am exempt under Section B&P.C. for,this,/reason-
N Date / r` _ Signature of Owner
t0 C\1
U
CL Q WORKER'S COMPENSATION DECLARATION
Z> Z I hereby affirm under penalty of perjury one of the following declarations:
ti 0 () 1 have and will maintain a certificate of consent,to self insure for workers'
K U compensation, as provided for by Section 3700 of the Labor Code, for the
Qperformance of the work for which this permit is issued.
Y] Q I have and will maintain -workers' compensation insurance, as required by
j U Q Section 3700 of the Labor Code, for the performance of the work for which this
i rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
? ? Carrier pACIFIC ERRi'Lo yEg Policy No. WLR .430843
--%
(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 prov;ssions,of Section 3700 of the Labor
Code, I�shall fort it h comply with thoser8%0nd,,
,.,,Date: — Applicant—
Warnings
pplicant Warnings 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 fooigspe6fion purposes.
,1zSignature (Owner/Agent) r•�' ' Date
v BUILDING PERMIT FERNY#
DATE / VALUATION LOTTTRACT '
JOB SITE-a-�-r ���f'`C` G
ADDRESSS. 511Qv'Xtgp1q.�Drii.d-N.�_.
APN
761P...fX40-0.+2x.9 i
`OWNER) !'
CONTRACTOR/DESIGNER/EN INEER
y'
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+ty9.i.b.7 L.PQM1I'i-v-
14TrE JtAVIT O�4
'14 M12-420
Ah Z -2 2-.
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74-923 •RqqT K-
74-9Avq10LES
.•' CA Q-2260
.IL' -J aLV3��.W t7.0 i
P.liLMWINE= ''CA '9220
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(I6004a96.99 MIX 3 W2
USE OF PERMIT
a lwu Yt f f11�13 �1 of
iFt R W* 3"r, PIE -1111A PLAN, PUMIT DOES Nar INCIALI IF,.&IID=
'iVAUA P001.4 SPA OR D 1VLVskV APPROACH '
CWTOM CONS9'AUCTI0I4
1�1..GA 4-12.00 Sly
Ci A�1rfC� 12 732,00 13F
HS'nW&RD COW OF CONWIMUCITON
27_`,=' 20
CONSTRUCTION PTE 101-000418-000 $112551ill)
PLAN OI•lWK 97.2 109-000-439••318 $1009.81
le' AC1i1` NIM �T% 101-0430-421400 311 SISO
tE1;.f.?ii:TRXVJU, FEIV 101-000-420-0GO $27OA9
PLUMB1,00 FER. 101.000.419.000 $162,30*
S'TRONOi MOTION R351D 101.000-244.000 W. M
(AAM10 FFV. 101a000.423-,000 320,00
31SYMEWH2.'4MPACT 1119 1{r1A :lYt►
ART IN 1?01131..IC Ivy&Cly - RIXIE Z70-00OF445-000 X108.38
• to ;. .
e1L1D70TAL CONMUMON AND FLAW CH901C
0.,856.72
P.W.1mr.M's NOW
CITYORAQUIfYh►
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RECEIPT,;. `�� ''f ,y -.
BY " 4- —^
'DA E AL
INS P TOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING 'APPROVALS
MECHANICAL APPROVALS
Set Backs no—
Underground Ducts
_
Forms & Footings /
Ducts
-
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
F.A.U.
_
O.K. to Wrap — ®
_ _
Framing
Compressor
_
Insulation
Vents
Fireplace P.L. I
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final _�
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste LinesLU
Heater Final
Water Piping ,%
Plumbing Final
Plumbing Top Out �_
Equipment Enclosure
_
Shower Pans
O.K. for Finish Plaster
_
Sewer Lateral
Sewer Connection �' Baa �.('�
Pool over
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
Final
Utility Notice (Perm)
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i.%.i•i.I.%'iii%%i.r'!i%/.t'//IN..I I//.V.'%I/I'ii/%:•.: '/.•1'. tJ
INSULATION . CERTIEICATE
This is to certify that insulation has been
f;
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installed in,conformance with the current energyF
regulation, California Administrative Code, Title 24,
State of California, in. the building loated at.
r
131-610 Tiodron Drive, Lot 8, The
Reserves PGA West, Rancho Mirage, California
CEILINGS:
TYPE: BLOW " MANUFACTURER: Certainteed
Thickness: R-38
WALLS.
;
TYPE: BAITS MANUFACTURER: Certainteed
• Thickness: R-19
GENERAL CONTRACTOR: TOLL BROTHERS, INC.
`
LICENSE #
BY:
TITLE:
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r
F
PARAGON SCHMID BUILDING PRODUCTS,
F
>
A MASCO COMPANY LICENSE # +132072
f
BY:
TITLE: ADMINISTRATIVE ASSISTANT
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DATE: 2/20/2003
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Al
.Yli wr: i. �/'rte✓�:.✓r• r'PA'N:.r,M.�/v.'r:I.:Y: w!A'.Y.%a:..
tl '
7 IS�LA�10 CERTi�fCAiE
�.
This is to certify -that insulation has been installed in conformance with ther r
f regulation, California Administrative Code,.Title 24, State of California, in the building located at:
current energy f
81-615 Tiburon Drive, Lot 31, The Resenies PGq West, Rancho Mirage, California A
t
CEI INGS.
` TYPE: BLOW, ' MANUFACTURER: C T
ER AINTEED THICKNESS: R-38
WALLS:
TYPE: BAITS MANUFACTURER: CERTAINTEED THICKNESS: k-19
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GENERAL CONTRACTOR: TOLL BROTHERS, INC.
LICENSE #
BY:TITLE.-
PARAGON
ITLE:PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
i
TITLE: ADMINISTRATIVE ASSISTANT
DATE: 2/20/2003
rr,'I.'iu.r./i;w'.�i.»:isJl'ryl,�I..'ll/1.J1iJ.titGrY+iJ/!i%i:I.11itl.'I.:/.Ii:I..rrJv %:slu:r.:illv.:ilc:I.(Biu.Hl:..ivi.:J.✓.'i'.r.�rli.,rrw:AYiliY,/�..v J.lir.: /J.i. i/✓.I.V rJL/v/;/%i.
City of La Quints
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: 81-615 TIBURON DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: TOLL BROTHERS INC
Building Official
IIRI
Bldg. Permit No.: 0204-082
Land Use Zone: RL
Address:
74-923 HOVELY LANE E STE 2-220
City:
PALM DESERT, CA 92260
By:
DANIEL P. CRAWFORD JR.
Date: 2/24/03
POST IN A CONSPICUOUS PLACE