0111-063 (SFD)T'
// LICENSED CONTRACTOR DECLARATION
M.408.40 3
I hereby affirm under penalty of. perjury that I am licensed under provisions of
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Ckapfer 9 (commencing with Section 7000) of Division 3 of the Business and
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Professionals Code, and my License is in full force and effect.
0,.m C"y
License# Lie. -Class Exp. Date
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PALM'. =1 4M. CA. 260
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Date Signature of Contractor - f,•w'°'�''
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' -BUILDER
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OWNER DECLARATION
LLI W
I hereby affirm under penalty of perjury•that I am exempt from the Contractor's
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License Law for the following reason:
Z(.
) 1, 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 exempfunder Section B&P.C. for this reason
Date k C-,/') 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
Policy No. , ,
1�.AG�'11'S4, �;A"tiRI�Yni9'3t?E� W::Eh. s.,.33i31943A
(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 provisions -7
'Date: ! :t lel) 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 $100,000, in
addition to the -cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety.
for a permit subject to the conditions and restrictions set forth `on his
application.
1. Each person upon whose behalf this application is made & each person`af
whose request and for whose benefit work is performed under or pursuant to
any permit issued as.a result of this applicaton agrees to, & shall,.inde
&,hold harmless the City of La Quinta; its officers, agents and emplo
.2 Any permit issued as a result of this application becomes null and v
work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancel)
I certify that I have read this application and state that the above'informatii n is
correct. I agree to comply with all City, and State laws relating to the buil ing
construction, and hereby authorize representatives of this City to enter on
the above-mentioned property.,for nspectio.-p6poses.
7
,,Signature (Owner/Agent) J - '` t Date
BUILDING PERMIT PERMIT#
t�
DATE JI VALUATION LOT ' TRACT
M.408.40 3
JOB SITE
ADDRESS "q -_C44.Ws TWUR.oxlimt
APN
7167^^x,5"- )
OWNER
CONTRACTOR/ / EN INEER
'ifJLI.� 1 RQUALE .S )WC -
TOLL "Elp--oT�� 11401-
74-92.3110V,£t3, Y L.A:t R40Y MY2-220
PALM'. =1 4M. CA. 260
PAL.' DE1.13M8111 CA W.,260
(f 60)674-9699 C2 vq 5832
USE OgFy PERMIT
� yy, A�q, �y. DWELLING
6 3J.e�,lY.171.['�bst,3fS1!.r,i
.
et11D- LOT 25i.%V6:.T.a'l'.AVAWJ-fH CJ"iwITA.PERMIT D=3 NOT 194: UDE
CUSTOM COAt131 RUCri'ION 4;-01,00 SY
PORCWPA'i`IO 314.410 Sr
(AAtAWCARPO T 7".00 Sp
1Y'fe:R&W "12 SuKkURY
C9C►S i,:,` RUC'.'6'IaN FEE 101.000.418-000
MECa�c;��i. Baa �Ovi;- 3 -o.effi
91 :3.PJC.&,t.. F1'. 101-000-420-000 X819,°il
PU,G$d1E 010 Z 101 -000-419-OW II9I;0.°aD
UTii:,rxNO MOTICd VZE R=1D 101 -MO -241-000 $36.14
O14ADNO FFS ,101.000.42.1-000 $20.00
G)ENY A PWI IMPACT T n;E X1,90) oa
ART 1NF41.RUC P ,a WF8 Ft SIE 27€1^000-4454M) �03.SY
SUB- -TOTAL C ONEfTM,i.T�'�iOK Atm PLAN C�3bX,'TG
11*,E 7:?.
TMAL 3'"�+�R. 4i'. IMES 33i1.K.N'�.'�w,
n"62,
DEC 0 3 2001
9 ffYOPL:AQU6�a1'A
F1E
RECEIPT
DATE I
BY
DATE
INSP TOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings u�
_
��d y
Underground Ducts
Ducts
Slab Grade
Return Air
Steel_
Roof Deck ���
�
/�ji� �. /�1�1�
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
FramingS
Insulation
_ y
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Party Wail Firewall
Exterior Lath
Condensate Lines
Drywall - Int. Lath
Final
Final`
_
i , .
POOLS - SPAS
BLOCKWALL APPROVAL
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
Waste Lines
_
Electric Final
Heater Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ _ _
/?j/Z/l6�
Pool Cover
Encapsulation
Gas Piping
Gas Test
��
Appliances
Final
COMMENTS:
Final
— At
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)
07/05/2013 02:42 FAX WJ uuz
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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 at
_81-585 Tiburon Drive, Lot 233, Rancho Mirage, Cal'sfornia
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-30 `
ii
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-19
GENERAL CONTRACTOR: TOLL BROTHERS, INC. LICENSE #
BY: TITLE:
.,:
PARAGON INSULATION, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT . DATE: 8/30/2002
INSULATIQN 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
VOID
CEILINGS:
TYPE: Fiberglass BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-30
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: V Q 1 D LICENSE #_
BY: TITLE:
PARAGON INSULATION, A MASCO COMPANY LICENSE #
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 8/30/2002
_.._.-.-.—__.�.�_.... �....�.�. �.�.�i�.ri.iv��.dNLA�s+�il�I/'/.^t,'s•(RfRi'FT�or.I/D.,li��I.fY.�O Iii/I
Smiliefasons
Al Miller ,Sons 12pgiitlt;
odn
flg
In't,
su 7s0'Surrunil l'fr. Phone: 760/316-121.4
Cathedral C,ily, ca,9223`1 FWX: 760/311-7097
ile
rrcx Qary "% y@1011,Br OUIOs PGA West
ax: 777-1.59f
From: Russ'Miller.
. --`.– - —ilk �.
®ate:
Re. Ins ecti+on 233
Pages: ..
GLiry / And.yf
'e' have:inspected all the .Roots at PGA West (Vistas and
Reserve). All , W6 s 5 are installed per the. O'H-
agin
specitscations and,
per'•your plans
Thank you,
Buss Miller °
T611r6ther�s In C.
Quality Homes. by Design
Au-llst" 8121001
Clt1` of La QUInta
Building & Safety De'partmelit
P.O. Box 1504
La Quinta, CA 92253
Fax: 777.7011
Re: Lot #
Project: ista (Tract # 29349-1) -or- Reserve (Tract.#2934,8-2) (circle one)
To Whorl It-May Concern:
This lever serves to advise you the O'Hagul roof vents have been inspected by the Toll Brothers'
represeiltative. The vents are as per plan to our satisfaction.
Should you require `any further inforn'iation, please.let us know.
i Sincerely,'
Andy'Fraser.
Project Manager
Toll Brothers @ PGA West
74-923 Hovley Lane fast Suite 2.220 Palm Desert. Ch ci?^gin
*Certificate of Occupancy
City of La Qdinta
r. Building and SafetvDeDartment
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: 81-585 TIBURON DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-063
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: TOLL BROTHERS INC
-7---4, /4-L47
Building Official
Address: 74-923 HOVELY LANE E STE 2-220
City: PALM DESERT, CA., 92260
By: DANIEL P. CRAWFORD JR.
Date: 9/4/02
POST IN A CONSPICUOUS PLACE