0205-247 (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
1, 7 99 B 4141 W02
Date�f % `� f Signature of Contractor=r�
1 � '
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 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
perfor ance of the work for which this permit is issued.
(rlmt�10P�
have and will ; maintain workers' compensation insurance, as required by
Se3700 of the Labor Code, for the performance of the work for which this
s issued. My workers' compensation insurance carrier & policy no. are:
Carrier pACIp1ft g1l p1AOYt kU Policy No. W1:X 043034315
(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, andAkgree that if I should become
subject tolthe workers' compensation provisifis/of Section 3700 of the Labor
Code, I h1l. in
oxih comply with those proylsl rys.
Date:(•Applicant—
Warning:
pplicant t j�
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
& 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- me nti oned property for' pe'tiurposes.
Signature (Owner/Agent) Date/7
2
{
BUILDING PERMIT PERMT>r
1
DATE it//�,r;r VALUATION ����,,(( s�y9nrt y9��yy LOT 'q 1'gl,f TRACT 29348-2 `7 r!
JOB SITE APN
ADDRESS ��-�i����Ec►��AY}., wl�Bi
OWNER CONTRACTOR / DESIGNER / EN (NEER
9'Ci'LT. Ci�e�T�J fid" li t", TOLL Bi s:.lTREPs 3TC'.
74.923HOVELY 74-92;x-ROVELYIAMB EXT1 fUrl ,?2*220
PXN DUM CA 92260 PAT.;I dr -In"` +�' a Cry 91260
(740)-5'74.9499 MJI- 3832
USE OF PERMIT
MYO12
Sri • LOT 11, PLAN QLill'dTATtA S. PERMT r)OLIS NOT INCLUD.
DIAXT WALIAl. POOL., SPA OR nR1V AWAY APPROACH
CUaTOM. CONSTRUCTION TION 3,41 X00 'I±
PCRCWPAi30 20.00 F
GxICVIJryKlG00 3000I7
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;SUB -TOTAL C IONSi'RUCTIM AM P I C"MOR
Isms
o
JUN 1 y 1002'
CITY OF LAQUINTA
FINANCEDE,: ;
RECEIPT DATE _ BY i5 DATE FI ,'{Ir�E I SP "TOR
C�i� r
CONSTRUCTION ME,%
101-000418-000
$112901150
,PL,4kXCHECK�?I:
MECRANI.M FEE
101 4*0421.000
$92.00
BL FEE
Af�?00-420y-Q�i i
$10.000
y11E��1**,��1y'�t�}.t��ttt;/�TI
11 /01
S'I`l;;fJNO MOTION TOM- - ,R=, 7
1 Cil •'000-Vc 1 -060
$281%
011 U1.OING M
)01-000,423400 00
$20.00
DEVELOPER WACT FEL
11A,+101.00
ART Ip,' PUBLIC'; PL,e CR - IiisMIE 270-CCJU-445-WO
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;SUB -TOTAL C IONSi'RUCTIM AM P I C"MOR
Isms
o
JUN 1 y 1002'
CITY OF LAQUINTA
FINANCEDE,: ;
RECEIPT DATE _ BY i5 DATE FI ,'{Ir�E I SP "TOR
C�i� r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts _
Forms & Footings
Ducts
Slab Grade
i
Retum Air
Steel
i /d
Combustion Air
Roof Deck
O.K. to Wrap
_ _
Exhaust Fans
F.A.U.
Framing
i
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROVAL'
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
/ 3
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection (/�(/ _ 1p p.,?
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVAILS
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)
1i
DEVELOPMENTSERVICES
(SOURCE CONTROL)
Coachella Valley .Water District, P.O. Box 1058, Coachella, CA 92236
(760) 398-2651 or 1(800) 262-2651 toll-free within the Coachella Valley
INTERCEPTOR/SEPARATOR INSPECTION
Name of
Address of discharger
VIOLATION OF REGULATIONS GOVERNING SANITATION SERVICE PART 9
(ACCEPTABLE RANGE) (INSPECTION RESULTS)
❑ LOWER EXPLOSIVE LIMIT 20 percent or less
❑ HYDROGEN SULFIDE 10 ppm or less
❑ PH RANGE . 5.0 TO 9.5
❑ GREASE AND OIL 150 mg/1
❑ SUSPENDED SOLIDS 500 mg/1
❑ BIOCHEMICAL OXYGEN DEMAND 400 mg/1
❑ Grease interceptor/separator capacity has been exceeded. Interceptor/separator must be completely
pumped to obtain compliance. Pumping receipt is to be provided at the time of the recheck
inspection on I
❑ Excessive odor in violation of the Rules and Regulations Governing Sanitation Service Part 9,
section 9, Subsection 9-1, (9) which states; "Any noxious or malodorous gas or substance in a
quantity capable of creating a public nuisance".
❑ Oil and sand separator capacity has been exceeded. Oil and sand separator must be completely
pumped to obtain compliance. Pumping receipt is to be provided at the time of the recheck
inspection on w "
❑ Excessive oil and/or grease in sample box.
❑ Interceptor/separator inaccessible for inspection, in violation of the Rules and Regulations
Governing Sanitation Services Part 9, Section 9-5, which states in part, "All interceptors/separators
shall be of a type and capacity approved by the General Manager, and shall be located as to be
readily and easily accessible for cleaning and inspection.
MECHANICAL MALFUNCTION DUE TO:
❑ 1. Missing sanitary tee in the sample box.
❑ 2. Baffle tubes missing.
❑ 3. Baffle tubes plugged.
x
❑ 4. Discharge line restricted.
❑ 5. Baffles are submerged due to a restriction in the discharge line, interceptor needs to be
pumped to obtain compliance.
❑ 6. Interceptor/separator inaccessible for inspection, in violation of the Rules and
Regulations Governing Sanitation Services Part 9, section 5, which states in part,
"All Interceptors/Separators shall be of a type and capacity approved by the General
' Manager, and shall be located as to be readily and-easily-accessible-for-cleaning°and-inspection": --•-
These violations must be corrected within 7 days of receipt of this noncompliance order
RECEIPT OF NOTICE ACKNOWLEDGED BY DISCHARGER
Printed Name and Title gnature
Inspector Date
MAR -18-2003 12:05 ,TOLL BROTHERS INC 1-•760 674 9081 P.02i02
is. INSUL-ATIQN CERTIFICATE
This is to certify that insutadori has been installed in conformance nth the:currergy ,.
• reguiation,.California AOminlstrative.Code, Title 24, State of� California, in the building located at:
• $1%640Titiurcn;Drive; The ReseN -.PGA West, t of 11; Rancho'AA�raga, California
C iN
TYPE: BAITS MANUFACTURER: Certainteed Thickness:
W AL:LS:'
TYPE: BLOW i MANUFAC URER: Certainteed Thickness: R-13
GENERAL CONTRACTOR: Telt Brothers, Inc.. LICENSE #
BY: TITLE; F ;
PARAGO S ID BUIL01 PRODUCTS; A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRAYIVE ASSISTANT DATE- 311812003
r Y M,Rr�WQ.lrgp�pJlG�p/vR/7.1�i7/1il.. f;'
�„�,.,r.,.yrto�e+.•.r�.1 �rofam�. •ae�N=a�/nKsenr - 1 , ^ .. F
r jERTrFICATE ,
�.
'INSULATION c , . �� •
-This is to certify that insulation has been installed in conforfnance vAth the current finergy.
regul2ition, California Administrative Code, Title 24, State of ,California, in, the building, located at:,
a1 -82S Tiburon Drive, The Reserves@PGA.West, tot 30i Rancho Mirage,, California
CEIL NGS:
TYPE: BAITS MANUFACTURER: CERTAINTEEO THICKNESS: R-19
TYPE:, BLOW
MANUFACTURER: CERTAINTEED' , 4, THICKNESS: R•30 T • .
o LICENSE #.
GENERAL CONTRACTOR: Noll Brothers, ---�
' ' � . • � r . TITLE: - ,. _ � � � • .
BY::
PARAGON C 1D BUILDING P OOUCTS,aA MAS
CO�COMPANY LICENSE # E,32072
dTLE: ADM1IdISTRATIVE ASSISTANT DATE 3118!2003`+
.BY: e
' S .� - �, -- -- --. __ _ ____.- - —=-�►�orac�uar„wvrc,:atcs��r• .en,2
TOTAL P.02
To]] r®thers, GInco
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 '# < l
Project: Vistas (Tract # 29349-1) -o(Reserve ract #29348-2) (circle one)
To Whom It May Concern:
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
mmerg'SOUS
Al Buller & Som 1?o0fi)il;
Boofingflne, U-760 Sununit Dr. Phone: 760/396-121.4 '
C'athodral Cily, ca 9223.1 FM 760/311-7097
Fii iinik.
`fix Gictry / t�wl(iffoll Bmt1jessPGA West
Fax: 777-1.5%,
From Russ.,`Miller
Cate: 3( I, 3
Re: inspec,tion.,,,, � . 'l •
Pages: ].
Gary. / Andy,
We have inspect cJ al the Roots at.PGA West (Vistas and
Reserve). All vent -'are installed per the G'Hagin
8pecitications and per your plans
Thank you,
\A�1\��
Russ Miller
,i
Certificate of. OccupancyofCity, of:La Quinta
_ ;. U"Dw�
Building -and. Safety Department SOF. ti
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:. 81-640 TIBURON DRIVE `
Use Classification: 'SINGLE FAMILY DWELLING Bldg. Permit No.: 0205-247
Occupancy Group: R-3 Type,of Construction: VN- < Land; Use Zone: RL
Owner of Building:=` . TOLL BROTHERS INC Address: 74-923 HOVELY LANE E STE 2-220
a - 'City: PALM DESERT, CA 92260
r r
1 .
x. By: DANIEL,P..CRAWFORD JR.
.�• Date: • 3/20/03
Building Official
3', ' POST'IN A CONSPICUOUS PLACE