0107-258 (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
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 am exempt under Sectiori , B&P.C. for this reason
Date„) w! Signature of Owner
WORKER'S COMPENSATION DECLARATION
Ihereby 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:
Earner Policy No.
tw::Im 04mono 1d�t, cam 31a
(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 thole proylsions:'
Date:'` Applicant
til 1 L . y
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 "fe
for a permit subject to the conditions and restrictions set .forth (I�i
application.
1.. -Each person upon whose behalf this application is made & each pe F t
whose request anis for whose benefit work is performed under or purs arit to.
any permit,issued as a result of this applicaton agrees to, & shall, ind gify
& hold harmless the City of La Quinta, its officers, agents and empl ILes.
2. Any permit issued as a result of this application becomes null andwork is not commenced within 180 days from date of issuance ofpermit, or cessation of work for 1.80 days will subject permit to cancel
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 inspecti2.,U"
rposes.
�
Signature (Owner/Agent) . ;)Date +y
BUILDING PERMIT PERMIT#
DATE VALUATION LOT u�x�i}I« > TRACT _
b... tm m fio \
29348"2 -
JOB SITE `'
APN
ADDRESS
%1614110' 14110'"24
OWNER -
CONTRACTOR / DESIGNER / ENGINEER
TOM MOTHMS INC
3 nom. y mi su7m?.--2o
74-923 HO Y L T ATE.SU11=420
CI 92260
PAT.aS MAW
OA 02260
1
60)674.9699
t;.`B11f 3832
,
USE OF PERMIT
Vs'NG12.'F LY :DWS f0
- PLA.W Slr! *NA- NVC ngCLUOP BLOCK WALUPOOL
;
OR NUVRWAY APPRs.3ACH
CUSTOM CONSTRUCTION 3,400 SF
PaR.t.ir1lP:ATIO "I.00 Sir
�.
QP%RA0FX.Alp`?0RT '722.00
7MUNA d:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts _!
Ducts l
Slab Grade
��� 6/
- -
Return Air \
Steel
Roof Deck
r%/y/
Combustion Air
Exhaust Fans
O.K. to Wrap
/� -y
F.A.U. 0
-
Framing
Insulation
ati)
/_ � /��p�J
Compressor -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/hop
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
Heater Final
_
Waste Lines /j��
_
Water Piping
J
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
�/ 3t7/� - _
Pool Cover
Encapsulation'
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vo ge Wiring
Min
Main Service ,
a
Sub Panels
_
Exterior Receptacles
_
G. F.I.
Smoke Detectors
Temp. Use of Power
FinalUtility
Notice (Perm)
._04/12/2002 15:32 9092920 SCHMID CONTRACTAWG PAGE 09/89
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
81-665 TiBURON DRIVE;1L QUINTA, CALIFORNIA 92253
- -- -- ---�- �--- -• -; ------- -TBI 26
CEILINGS:
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Coming THICKNESS: R-381 !"BLOW
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Coming THICKNESS:R :1 51/2"
T
a GENERAL CONTRACTOR: TOLL BRQTHF-RS, INC. LICENSE:
BY: TITLE:
a
SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2 Y
y BY. v TITLE: PRODUCTION MANAGER DATE: 4/' 2102. ,
-rs.�.._.1.�,w,�.�.,r.;�.:.��•-a•-�..-.�•-••x.�.�.s�-c:z:�.::.v.:�.,�-:z�.:zzua�r✓cr.»cr.=.,:.^.�x_ars�_ •rvra:rr�.xr,�_:� �_.rr"_.����.s�.:��:
1 ,
K INSULATION CERTIFICATE
y
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 locat+ d at
81-665 TIBURON DRIVE, LA QUINTA, CALIFORNIA 92253
TBI 26
.'Y
Y
CEILINGS:
TYPE: Fiberglass BATTS MANUFACTURER: OwenslComing THICKNESS. R B 12" BLOW
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-21 5 !2"
GENERAL CONTRACTOR: TOLL BROTHERS, INC. LICENSE #
BY: TITLE:
SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2
BY: TITLE: PRODUCTION MANAGER DATE: 411210
1
6 1U.Mmemsoms
Al 1Viillce & Sn11S R��gfi�tp
U-7bO.Sl,nit Dr. Phone: 760/316-1214
(,ily, C9223tBodnolnc.
Fwx: 760/321-7097
-FWimik
` ix Gary / A.Ddy(«Voll Bmklue. PGA West
Fax: 777-15%
From: Rus' yMiller
Date:
Re:. (nspecjign. /-o T ��
Pages:.
Gary / Ahdy,
We have inspe:" d all the Roofs at PGA Vilest (Vistas -and
Deserve). Al! vents. are installed per the O'Hagin
SPecifications and per your plans
Thank you, �
Reiss, Miller
Toll�Brothers,Inc.
Quality Homes by DesignO
City of La Quinta _
Building & Safety Department
P.O. Box 1504
La Quinta, CA 92253
Fax: 777.7011
Re: Lot
Project: (Tract # 29349-1) -or- Reserve (Tract #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 firrther 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
7Fn-674-arca F.".