0006-395 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions, orf
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
7 04/30/2(
DateSignature 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 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.
.(-,Z')--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:
Cartier 0ENEtRALACCIDEN7 Policy No. i 00161102-a7
(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 wor ers' compensation provisions of Section 3700 of the Labor:
Code, I shall jo�rt with comply with those provisions.
Date: C04 Applicant—
Warning
pplicant rf
Warnings / Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his ;a
application."
l
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
,construction, and hereby authorize representatives of this City to enter upon L
the above-mentioned property for inspection purposes. Via,
/�
.Signature (Owner/Agent)4,�2 � Date "p
�I IJOBUILDING PERMIT PERMIT#
LOT TRACT
DATE VALUATION a2
23,49X.10 I$> 29348.2
ADDRESS r .R C�A� a Yrs!
APN 767-530-•016
OWNER
CONTRACTOR/DESIGNER/EN &NEER
'T'OLL BFi O IMRS INC
IMLL BRO E3RIA n4c
74.923 HOIiELY LAM LAM RMEZ-220
74.923 H0'VW Y LANE FAST Bi3SS92-220. I
PALM DESERT CA 92260
PALM DFIRPRT CA 92260 -; ;. ' -
(760)674-9699 CK, # +3832 ;
USE OF PERMIT
33?O•PLAMCASTILLO LOT.18 PXRMIT OURS NfYr I14CLU DY, 3LOCK4ELLS
03. POOL #-
CUSTOM CONSTRUCTION 21433.00 :3F
PORCWPATIO M.00 SF
0Ai#,AK1F.lCAR.?OR�I (S[) 9.427.60
ESTD"TED COST OF C"ONSTR+TTG'! [ON E
223,491.10
Moor FEE HIMO/lARY
CONSTRUCTION FEB 101.000-418.000 Si;a"t3,54
PLAN CHECK = 101-000-439'-318.j $876.23
MECHANICAL L FEE 101.000-421.000:' $42.00
W9,CTRICAL FU 101.000-420.=, $156.20
PIA MEt1NG I+EE 101.000-419.000 $185,50
STRO140 MOT1014 "M - REStID 101-000-241-000 $22.35
CRADINO SIRE 101.000.423-000 $20.00
DEVELOPFR IMPACT "E $1,91Y7, 00 .
AE;•C 110 PUBLIC PLAC98 - RESIE 701.000.255-000 $58,73
ME DPIPOSIT 101-000-439-•318 -V750.00
Fb �,
9
SVJ3-TOIAT, COWdM"f2C1MION AND PLAN CHEC ,
$4,392.51
PARE -?=AM MS
AV50,00
PA,K)x.95
•gout _s, mmr ms DvE wow
033,642A.51
AUG 0 8 2000
l
q�(�"
QF '�dII "''
.PI &i U
RECEIPT
DATE%
�BY'
DATE FINALED
INSPECTOR
7
w04
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
Exhaust Fans
0. K. to Wrap /
F.A.U.
Framing
Compressor
Insulation
- Q
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
/
Final
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)
COMMENTS:
JUN 11 200-1, 1:49PM.' SCHMID#C_0NTRRCT0RS: 7603471897; p.+
INSULATION, CERTIFICATE
this Is to: certify that Insukd1ori hasbeen installed in coriftffnence with. the. current energy,
regulation,
ulation, California Administrative- Code, T10924, State of C'alifbrnia, In the building at
THE RESERVES @ PGA WEST
LOT Is
CEILINGS:
TYPE-FibergtawBATTS MANOFACTURER:Owens/Cotning- THICKNESS:. R-30 9172" BLOW
TYPE: Fiberglass sATTS MANUFACTURER: Owens/Coming . THICKNESS: R-30'9 W.
WALLS*
TYPE:'Fiberglass Betts MANUFACTURER: Owens/Coming THICKNESS:R-19 61/2"
GENERAL CONTRACTOR: TOLL BROS-INC. LICENSE:
BY: TITLE:
SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2
BY: TITLE: PRODUCTION -MANAGER DATE: 06/11/01
INSULATION CERTIFICATE:
This is to certify that in.suidtion has been installedinconformance with the current energy
regulation, California Adininistrative Code, Tifle 24, StaWof Galiforniai. inthe building located at
THE RESERVES @`PGA WEST
LOT IS
CEILINGS:
TYPE' FIbergIfts -BAITS MANUFACTURER: Owens/Corning THICKNESS:. R-309'1/2" BLOW
TYPE:: Fiberglass BATTS MANUFACTURER Ow,ens/Coming THICKNESS: R-36 9 Ya"
WALLS:
TYPE:. * Fibbriglaw Batts MANUFACTURER: . Owens/Coming: THICKNESS: R-19.6 me
GENERAL CONTRACTOR: TOLL BROS-.1INC. LICENSE #
.BY:, TITLE:
SCHMID, INSULATION.CONTRACTORS, INC.. LICENSE. #221517 C-2
BY: TITLE: PRODUCTION, MANAGER DATE: 06/11101
Certificate of Occupancy
City of -La Quinta
Building and Safety Department
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
ollowing:BUILDING ADDRESS: 81-720 TIBURON DRIVE.
Use 'Classification:: SINGLE FAMILY DWELLING Bldg. Permit No.: 0006-395
Occupancy Group: R-3 Type of .Construction: VN Land Use Zone: RL
Owner of Building: _ TOLL BROTHERS*INC
Building Official
Address:
74-923 HOVELY LANE EAST- STE 2-220
City:
PALM DESERT, CA., 92260
By:
DANIEL P. CRAWFORD JR.
Date: 8/22/01
POST IN A CONSPICUOUS PLACE y