0208-350 (SFD)LICENSED CONTRACTOR DECLARATION
I4fereby affirm under penalty of perjury that I am"licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
WProfessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
LO
LL1 7 77 69.9 13 4110103
Or Date Signature of Contractor °
OWNER -BUILDER DECLARATION
W.� I hereby affirm under penalty of perjury that,I am exempt from the Contractor's
d License Law for the following reason:
U) -
Z_ 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). =
cY)() I am exempt under Section , .B&P.C. for this reason
r; O Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
�
I hereby affirm under penalty of perjury one of the following declarations:
0 () 1 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
J Q performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
rS,eet� n 3700 of the Labor Code, for the performance of the work for which this Z permit is issued. My workers' compensation insurance carrier& policy no. are:.
Carver PACIFIC Policy No. WA,--C00843F8
' 0h
J (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
3 subject to the workers' compensation pr Dons of Section 3700 of the Labor
Code, I ha I forthl itb comply with tHdse p1jo�isions.
Applicant % M 6 6
S r
Warning: Failure to secure Workers'' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in,Section'3706
of the Labor Code, interest and attorney's fees.
IMPORTANT *Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his.
application.
1. Each person upon whose behalf this application is-, made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this'applicaton agrees to, & shall, indemnify s
& hold harmless the City of, La Quinta, its officers, agents and employees
2. Any permit issued as a result of this application becomes null and void i O
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellation
I certify that I have read this application and state that the above information)
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize repres ntatives of this City to enter upo
the above mentioned property for i4pd t n . urposes.
Ignature (Owner/Agent) 1 t Date 4�
BUILDING PERMIT PERMIT t/
DATE VALUATION �Ayr��j /[ spry LOT t TRACT.
47.
JOB SITE - ' "
ADDRESS i! .`, Lrpi '_lyww �
APN
761-w1M-U
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TOLL PAR(YrIV.W WC
l-YU,BROTHt?,1}.5 WC:
74.973 HOVnY 1AIMB 31"A `r ff=12 =
74-9T3 HOVEIZ LAM, :BAST e5`�,J+.i•i:; 2-22U
CA 92260
PALM U"'ElI f CA 92140
1760x)04.9699 t %3f 3832
USE OF PERMIT
swaiaTW+�Y'l:)WrMLINCT
SMS — LOT 10 - SM -14 -NA- A, W. Cd MT..A. PPOLNUT 00= NOT
1N(:I.1LiDE 8I c)CK WAL IA POOL„ SPA OR DR 1V SWAYAA,1'MOACH
CUSTOM CON31 R. UC T 1014 �my 5F
POit(;Adk>;P TIO 047. Do Ser
C7tA.F1,A&9A#�,.1•'iti1Z.$ f3f1a,"�� SFt
.iC7 dad�.Ld7A 3:+�', iorOF cJtClAAM10JS
321,156030
•{`g r�•�, /�
31'.IC.ahlti"lA1 Ay�
IM 811JAWA6
CC',MST1'AX 1'I00 FEE 101-000-1.8-000 $1,4100
Pt..AN CHWIr. rEE 301-000-439-31.8 $1,140.33
MECHANICAL T -TZ 10141300-421 pO00 $1.11100
MECTRICAL FU 101-000-420-0010 WO. 60
PL1}MBINO F13 101.000419=0W 31981.x3
STI?-ONQ 1yifCs't ION 1• - R.231D '101 -000 -241 -WO O $32.17
CtR"EAiOV11f I: 101-000.423.000 �1ti,4f3
I)Z%rEl.OP'ER IMPACT ?Z2 ��,80�.f9i►
.A.Tif't rN PuTiLic PU&m - WMIT. 270.1300.445.000 S.ap4.di
pie ! 9UP,4r4.7'1.AL t✓ON�`h'1 UC-11U9AM MAX CW . ' C
I&SIS RR—TWD MID
TOTAL 11.R RWIC I111TS JYGE 1qCFw
� � �•2�
SEP 2 5,'
j" CITY OF LA AUINTA
FINANCE
RECEIPT
DATE "'
BY
SATE A D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
d
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lathny,3
Drywall - Int. Lath
?J
47,
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
�p
Main Drain
Bond Beam
_
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING AP ROVALS
Gas Test
Waste Lines
_ ���
Electric Final
Heater Final
Water Piping
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
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)
a
INSULATION CERTIFICATE
L
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:
a
81-630,Tiburon Drive, Reserves @ PGAWest,'Lot 110, La Quinta, 11aliiornia
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEEb THICKNESS: R-30
WALLS:
i TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-19
a
GENERAL CONTRACTOR: Toll Brothers, Inc. LICENSE
BY: TITLE:
PARAGON Ct;MI ING PRODUCTS, A MASCO COMPANY LICENSE# 02072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 41'30/2003
_.. _- .. ._..____-.__.._.-._._.-._.-.-..-.�.-......:....-....�::-.-�:-.-:...�.�.�,r.,.'r. ..-..: r.r.r: rr.rr.a..;rir.WimcwcJS:'.O.Y;i'YG:OfO`/I.�O<"Y.+<:O:PO'FV. i'�.O<^.VP Jr`F!TB. S.•6�
i •
Ir
INSULATION CERTIFICATE
F 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:,
81-635 Tiburon Drive, Reserves @ PGA West,' Lot 29, La Quinta California
r. CEILINGS
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS-. R-30
WALLS:
TYPE: BATTS , MANUFACTURER: CERTAINTEED THICKNESS: R-19 �.
GENERAL CONTRACTOR, Toll Brothers, Inc. LICENSE #
r
s;
BY: — TITLE:
u
A PARAGO SC 10 BUILING PRODUCTS, A MASCO COMPANY LICENSE # 632072
f 5
t y
g 1
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE:. 4/3012003
+<•�•�s..r�-i.•�,.►rr..•risR : •�.' r�...�•w,,...�.�•�,-�. �.e�-��s.�erwrruv.ie.�:w�xsrsrre.•arv..Jrawvsvrv..':.,sn..rroraio.. w>...w•.o,.r.�,ow•s.r•ii.'o.��v.e... o.o.�uuw ssr�
Al Miller & Sons
Al Miller. & Sgns RUgIiip
.
Rooflng
Inc. bu-neo Sununu 11r: Phone: 7Ei0/3�F,-] 21.4
C:ath('Idral C.;iiy, (1,1,q-) &1. tiX: 760/321-7097
FWim�t 11,0
Tlx Gm—y / Aixiy@@,roll ISI-btj-wxN- pCwA'West
FXX: 777-1.59%
From; Russ Miller
Date: 6o1I31t>3
. Ike: ' Inspection `-O7—
Pages;.
G -31.y Andy,
We have inspected all the Reefs at PGA .West (Vistas and
Reserve:). All vents - are; installed per the Q'Hagin;
sp cificatiot s and per, your plans
Thank you, `
Russ Miller
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Cerrincate;-"of ccupani...-�
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141
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'p� �`', i,1• y ~ - '•••t n+ ' `�c� .! _ af~ �. •� ,- w
OF 9 -` 'v �% Buildin .� ki
g �& Safety Department' `
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=This•CeAificate is issued pursuant,to tt a requirements of.'Section 109 of the California'Building
�
-. �� - '- �-
:'Code s
;s certifying that,- at the ;time . of issuance,, this structure, was# incoinpliance with the
z
r"provisions -of 'the Building "Code and the various'; ordinances of the : City regulating' building R '
�� r
construction and/or, use,
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BIL16blNG�ADDRESS: 81-630 TIBURON DRIVE '
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_ Use classification: SINGLE FAMILY DWE_LLING }; ` .+ L' rFr 1 ', Building Permit No.: 0208-350
-' Occupancy Group: R-3 _ �� "` Type of Construction: -VN x• w + :� 4 Land'
'� Use"Zone: RL
77
Owner of,_Building: TOLL -BROTHERS INC, i ', i ;.�� : .Address.,74-923`HOVELY LANE E STE'2=220
`" �,.. f �" ,, � - { - � Oyu. '..a rt�•r, Jr � ;.t.z ST,ZIP: PA- LM'DESE„R4'•T:
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C`it-
C �` *�_
.'_CA., 9.w2J, ;60
yF,
BY: Daniel P. Crawford Jr
L, ,r �.y r �� �. - �� -� . Date: 6/23/03,
:., ..�,.
Building
,Officials
.71
POS T'IN A CONSPICUOUS PLACE'
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