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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
�.��i` � ..,�� ✓ if ��,.-. -,,-„
Date '� '" Signature of Contractor
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
( ) 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.
�
I have and will maintain workers' compensation insurance, as required by
Sect&on 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 PACIPIC YCb PLOY.C1?I Policy No. Wt C`43084318
(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,'prov&slons.
Date: Applicant ,',
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. 4
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 inspection purposes.
S' nature (OwnedA ent) t!d ' `, ' Date
BUILDING PERMIT PERMIT# }
i?'°+,03-26�� rr'
DATE VALUATION 921/01359-V
r LOT, — TRACT 29348-2
JOB SITE
SSBI �J et.a+c�ASa
APIN
N.Z^M%S
OWNER
CONTRACTOR / DESIGNER / EN &NEER
7 1011L BRaIRFIRAI INC
74-923 flO LY U�N1✓ FaAUT UUNTr2.220
74-!M llt:9'�"+MY 1AW E-AYr 90ri'Ez :-.220
PALM DEM(T CA r4260
PALM DFMT CA M60
(160)614.go9 t..' Lit 3836
USE OF PERMIT
SING E'FAI\MY DIMLING
SPI) - LOT n, i+IA.YARRO A PLAN, PERMIT DOE3 NOT )NC:LU02 .
:BLOCK WALLS, P006 R11A OR DRtV KWAY APPROACH
r
CUSTOM CONSTRUCTION vnxo ur
POIt4:WPATIO 3119.00 Sly
OARAC.41CARPORT
1rGAMWIMf cost OF co-MTR10Mon
27%f9.30
P'ERMT M 9UA0AAR`!f
CONSTRU(NION FEE 101-000-438.000 �9,d33.40
PLAN C;H10,CK FL?,E 101-000-139-31€I
AtiECHANICAI, RRE 101-000-421-000 moo
FILEC-'f:'RICAL FRLT 102--000-420-000 $18VA3
I°'taUMBING RIF, 1 ill -OOO 19.000 $169.:v
5TRONG MOTION ME - "SID. 101-000--241-000 $17:04
0fiADrma FF.R k (93 -000.421.000 $20.00
3)L'VE OPXR IMPACT T'>n:L+ $1,,9tf 3.00
ARTIN PUBTAC PLACES - R.1sSH 3'70 -000.445 -OW 175.00
411 .
:iCm O'I'AXr 0.1 3CTSON P.WD PLAN Cl MCK
$4,798.02
LES31 PRF -PAID IWN
t
$0.00
I .�Y' ' fAL P Irt'ES ftt NOW
$4,7=412
APR 12 2062 i�
CrrYOFLAQUIRTA
RECEIPT
DATE
�r -{:
BY
DATE FIN ED
INSPECT
}.
1W
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
qz> lm_
Exhaust Fans
O.K. to Wrap
t
F.A.U.
Framing
_
L t7
Compressor
Insulation
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
L !1,11p Ivor
Final
Final
POOLS - SPAS
BLOCKWALL 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
Electric Final
Waste Lines
0_
Heater Final
Water Piping
_ A _
Plumbing Final
Plumbing Top Out
Shower Pans
_ _
I�� 1
Equipment Enclosure
O.K. for Finish Plaster
Sewer Lateral
_
v
Pool Cover
Sewer Connection
/ py L( rl Encapsulation
Gas Piping
Gas Test
trL
Appliances
Final
COMMENTS:
Final
GiAs.iG�6Tfi�- �ad 7_•C:�7
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)
U23i1.t1/ZU23LU:15 F,1X 16001
INSULATION CERTIFI ATE
1 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 Tibu ,Lot 27, he Vistas;(' PGA Wast, Rancho Mirage, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness:. R-38'
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-19 +
GENERAL CONTRACTOR. TOLL BROTHERS, INC. LICENSE It
BY TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO. COMPANY LICENSE # 632072
B _ TITLE: ADMINISTRATIVE ASSISTANT DATE: 10/1112002.
{
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 241 State of California, in the building located at:
81.650 Tiburon, Lot 12, The Vistas @ PGA West, Rancho Mirage, California'
CEILINGS
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WAILS:
TYPE.- BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-19
J
GENERAL CONTRACTOR: TOLL BROTHERS, INC. LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE #632072
TITLE. ADMINISTRATIVE ASSISTANT DATE: 10!1.1/20024
r
. i
Tali rothers, GInc.,
Quality Homes by Designe
ttgust 8, 2001
CITY of La QulnTa
Building & Safety Department
P.O. Box •1504
La Qulnta, CA 92253
Fax: 777.7011
Re: Lot #'2-7.9F-- - 2C �
Project: Vistas (Tract # 29349-1) -or- Tract #29348-2) (circle one)
To Whom It May Concern:
This terter serves to advise you the O'Hagin roof vents have .been inspected by the Tolt Brothers'
representative. The vents are as per plan to our satisfaction.
Should you require any further information, please let us Imow.
Sincerely;
Andv Fraser
Project Manager
Toll Brothers @ PGA West
74-9_23 HovleY 1-8119 i_ 75[ SLI"U' ')-^ 4 a
_7 o Pahl De§&t. CA 9ow;n
Al Miller' SoHS
At miller SUm Hoofilnp
'
Roofing
incN bll-76U Sununit Dr. hhohe: 7fi0l3�lfi-121.4 ,
Cathedral Cily, ca yz�3'i �'.ix: 760/321-7097
a~ o
777-1.5%,.
from: Rus's� Miller
Date: /0
OZ,
Re: inspect or�,�. p�.7
'Pages: 1.
Gary / Andy,
We have inspec,t',eeJ all the R®ofs at PGA West (Vistas and
Reserve). All vents are installed per the O'Hagin
specifications. and -.per yeur plans
Thank you,
Russ, Miller
f
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