0403-020 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
�-hapter 9 (commencing with Section 7000) of Division 3 of the Business and
rKofessionals Code, and my License is in full force and effect.
License # tic. Class Exp. Date
777699 13 04!301''Z(
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:
( ) 1, 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.
( ) 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:
Carrier LIBERTY MLiiTU,g,1,, F Policy No... bV3'�2b�1�0��234f�1'.f.
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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 sh 911 forthwitli'comply with those prov dons.
Date: /1 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'
fora 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-mentioned property for inspection purposes.
Signature (Owner/Agent) 9e w �� �_. -•. Dated =�
BUILDING PERMIT PERMIT
DATE VALUATION `9363 LOT 137 TRACT ¢Cf3�7
JOB SITE JA6
ADDRESS tya��5j
APN
772-X70-B181
OWNER "'
CONTRACTOR / DESIGNER / EN (NEER
T0171, T3 RO rt,*]R9 ACI ',1..1?
p1allw"IR's R ITIC,
73.121 PR !�''>F3APNG.0100
73-121 RRM"NA) D-TC3 4100 -
PAL3vI DWEXr CA 92260
P%1M DTrtSWr CA .92,260
(7,60)57=1.,,9699 C.B.L# 113.2
USE OF PERMIT
SFO • LOT 1.3'7, V..F_HTA.VA-AJL1.;itd, 4'. PkPLAdIT Doss 1V r
INCLUDE SLOG . WALLS. P00.12 811A OR 13bW INWAY APPROACH.
CUST6 M, CONST.RUC1`ION 4,374•,40 3P
a �A.fWNEICAYIPORT posw
r
.'1'XD COWC OF �°l'�.�'Nr':L'�i1"tw'"�10N
' 3E�UYV7.60
(�y FEW
�3AIaXg''p�Y� -Ki FEW ffom. 1ARY
CONvi3►:iJC'!'IOW MI 101+000-4.I 8,0W $1.,563,50
"PLAN CHECK PIZE 101-000.4.119-311.8 $3,267,4; .
IU OCHANIC.AL PER 101.-000.421.000 $156,50
k�3.' t:`.fk2iCA C. FEE 101.000,420-000 $703.69
1'1.U1u1OING PC, E 101.000.419.000 421100
STROPU 9407" GN FZZ RE.SID 101-000-241-000
ORADIN � FU 141.000423.000 tj $IOU
DEVEWPER IMPAC` FE9 $:4405.00
ARTIN POBLH' PLA.C,Z1-1i.)rStt:.270-000.445.00.0 $40122.
OUB -W1°AL csONF, n.TJ=o_0N AtW IYLJW CEWLCK
PIZE-WID r1-Tes
t
De aLESS
r ..' 1 L, pr -.W4 r: 134110 7.11f€'3'W
$6,269.73
MAR 11 2004
CITY OF LA QUINTA
FINANCE DEPT.
[RECEIPT
DATABY
<
DATE FIN L
INSPE OR
Y
7
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts — -
Slab Grade
Return Air
_ _
Steel �_
Combustion Air
Roof Deck _ —"b _ _ _
O.K. to Wrap ,.
Exhaust Fans
F.A.U.
_ _'_
Framing 7
Compressor
_ _
Insulation ,
Vents
_
Fireplace P.L.
Grills
Fireplace T.O.
Fa96 & Controls
Party Wall Insulation
C ndensate Lines
Party Wall Firewall
Exterior Lath /1
Drywall - Int. Lath (�
Final
Final
POOLS -SPAS
BLOCKWALL APPROVAL6
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING PPROVF.LS
Gas Test
Electric Final
Waste Lines _�
Water Piping
_
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection `/✓/.�
Gas Piping
Pool Cover
Encapsulation
Gas TestQ
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)
13 1
c i
clj
> C a OF LA QUINTA
'
... a W & SAFETY DEPARTMENT
OF Q _ O z 777-7012
CTION REQUEST LINE
r;
{.. 777-7153
.
OT RS, INC.
)iwner INC.
" ='- TOLL BROTHERS,
tractor -
0403-020
�ermt'Number
JOB IN CONSPICUOUS PLACE
POST ON
SIGN APPLICABLE SPACES
--`ALL
..INSPECTOR MUST
80=605- V�AiTALAVERA
�---`--�
JOB ADDRESS
��'� r 137, VENTANA-A/casita/4'. PERMIT
.
yLOT
NOT INCLUDE BLO w�'LS, POOL, SPA..
IDOES
OR DRIVEWAY APPROACH
k., INSP.
DATE
SYPE OF INSPECTION
.TEMPORARY POWER
SETBACKS
U%G PLUMBING / WASTE
—_
&G -'ELECTRICAL / GROUNDING
FOOTINGS f STEEL
CONCRETE' SLAB
NOTNE
`POUR CONCRETE -,TI
v
>= .DO.
�ROOF,NAIL /PRE=ROOF..: _
.!
,
O- TO:WRAP,
r
NG COMBINATION
UGH -ELECTRIC
:
Y: ;
s:
ROUGH..PLUMBING
4 K .
ROUGH;MECHANICAL_' �
-LL-(',g1lER NO WORK;UNT ;ABOVE :SIGN D
1
111NTERIOR;GP BD DRYWALL
r r
Ej(TERIOB LATH
sCa 'S4TEST Y
'S EE CABANDONMENT `'
UiSEWER:GON'NECTIOIv-
_. _
;`SEPTIC/`GREASE INTERCEP.T.OR
Y., MASONRY INSPECTIONS
+_ `FOOTINGS /STEEL=-.•
BOND: BEAMr-.
'-POOL / SPA,/ WATER FEATURE INSPECTIONS
PRE-GUNITE /'SETBACKS'
U/G"PLUMBING:,
U/0 -GAS _— k
;U/G-ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
' -ELECTRICAL
BING
ANICAL Z
PUBLIC WORKS DEPARTMENT
IIIA
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
..
MOWN
Cdrrirca tof Occu. anc-�
Tat ,
,
s .. j.YWGD0 RATSD ,' St •, ^' V i` t� J! y �.� :R s • (Y 'r
Building'A
of =Safety-DepadM_ ,ryt�`
'This 'Certificate "is issuedpursuant to `the requirements of Section.,109 of -the California-Budding ,.
Code,: certifying; that, r at- ,theF • tinier, of: issuance, `.this `structure` was ''in compliance with the
. _provisions of the- Building; Code. and the 'various :,ordinances of they City- regulating building,_?
Construction- and/_ or use. t % •Y - ��+ lr
_
•1
AI
BUILDING ADDRESS: 80-605rVia'T61avera
fi. C ♦ x.45 , .a - � +' — -+t,- -.
.,..`
-
J - Use classification: Single`Family`Dwelling .. ' ' �; �� .Building'-Permit No 0403-020
Occupancy.Group: R-3 4Y r Type of Construction: VN Land_ UseZone: 'RL
Ar
Ownerpf Building -Toll Brothers-Inc. t- Add+ress-73-121-Fred�Warirf - - , _
q #100
t City, ST 'ZIP: Palm Desert, CA`92253'
Daniel P. Crawford Jr.
.;
,r
Date: 1-1/5/04.^ • �` �.
. ,�. Building Official
a �
k` ' POST IN A CONSPICUOUS PLACE -