0210-177 (AR)LICENSED CONTRACTOR DECLARATIOd
:•i hereby affirm under penalty of perjury that I am licensed udder provisions of
Chapter (commencing with Section 7000) of Divisi'uii:3 ot.�the Business and
Professionals Code, and my License is in full force and effect'
License # Lic. Class Exp. Date .
`_fief
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 Section , B&P.C. for this reason
Date Signature of Owner 0
I�
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,pfor the
performance of the work for which this permit is issued. •r
( ) 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 J)A(!ik'?G :�/1.3� f�Y3;ds� Policy No. MR CA3624:1I9
(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 an agree that if I should become
subject t?/the workers' compensation provisions Of. Section 3700 of the Labor
'�. f Ji P i ✓ ovis yr
Code, I shalllfo ;with comply with those provls10 s.
D.ate.�'�r� � Applicant � ��� 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-,!9
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 applicatiopaand state that the above informations
correct. I agree to comply w(ih all lit t and State laws relating to the buildin
construction, and hereby authq i; , representatives of this City to enter upon
the above-mentioned propertyafo I'nspe�Ctioh purposes.
e �
/ Signature (Owner/Agent) `, 1� A * Date
NV�` \`t —
PERMIT�#�i
'
BUILDING PERMIT
DATE VALUATION p LOT TRACT
30 29�49-1
JOB SITE
ADDRESS��..fi 3Rg ya��`��si�
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
':Fora., B3.O TkMS DITC
TOLL B1tOTIWIS .INC
'14-923 NOV-.�LY .�1� �1 �� (A��'.x^`baa
74-9Z31T0V , ,Y.9.,.E r�.�tiW UL 2- -
PAYA1, DM—, E.r M 92260
Is til. M DEZIER"t. cAP .. 92260
(760)674x9699 C-31di- 3832USE
OF PERMIT
SUPPI:fMMfj°d+a7°a1.T.,'f'KT';Nk'R,Yi+IT#0203'34&,e1001140 3113,I'. (",.,SMA TO
:'sF7 WHIM U'RDEri CbW03`I WLTC'TY0 (VEX't''.ANA)
CUSTOM OM CaNSi`RUCT3019– 317.00. :ter
}
CONS !'3° UC f ION P: w 301-1000-418-000 S", 50
PLAN CHErm FP,
FER -000
hLEZ111PUCAJ,FRK -000- 420-000 $0.(}9
PL,[fMMr 0 ME • 101.000.419.000 $18.00
S'T'R,ONO MOTION PEP", - RY ID 102 -0 -DO -7A11000 $2.47
.ART 'i'9.,J PIVIDT Fr'+ Dr A^V0 _ 'OV1011- g�n.:f4a'19i_,ii .:C _,nuR�"ri ar.� ftn
Vr Y!_YaM aa.xvs :illi ^ L�AYIY, A. A�.♦ V^4}lIW�T•7d ^yiiW aziY �,. fes'
.
...
�p` •�,� �+''� -yam
.i .0.t . ,,.�.eV �.n0.It, LK
IX SS PRZP ITT, VM)
$0,00
1st.! 6 DU now
��.� ���►7
�
RECEIPT
DATE
-BY � �
DAT. FIN LED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final ' o
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
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
�FInai
Utility Notice (Perm)
COMMENTS:
Vezzeo�s
i
FILE No.221 0221 '03 AM 08:02 ID:YTC/EDAIS ENGR.
FAX:520 3411075
02�-Viv60`7
(92.3) 34.4•-3566 J AX (92t1) 341-1075
r:T'fAI},; yttp?11�aiu�trL�ee.corn
PAGE 1
F I CSIMILE TRANSMITTAL
ATTN: ITODD FROM: WESLEY
-7—
I
i a j
COMPANY: TANDEM WEST i TOLL BROTHERS PAGES:. ;JIacludes cover page.
FAX: 7602'188-2145 _..7r/ / JJ e�, DATE: 02/21/2003
4
OFFICE: ! Ic7c.
RE IENGINEER TRUSS REPA
urgent Ekor Reviv%
COMMENTS:
If you have any questions", please calf
Thank you,
Wesley
t:'omment
11 Please Reply
FILE No.221 02/21 '03 AM 08:04 ID:YTC/EDAIS ENGR. FAX:520 3411075
02/21/2063 07:13 &QQER STES. INC i 19283411075
P4070MH r. AW TRUN t ,
i
Utw�► TIIUS9 t01rPAror. WW AZ e�J6S 0,01 i Nov i8 2000 MITeY iAeuttMe, IpR• Feb t :a0
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sac i'r ',' /� 8
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. I
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7
PAGE 5
NO -873 962
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8-4-4 ks-D. 11-11-•0
f...-._a-.� i �}-
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RLL i j a W� 2-0-11 CSI
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TCR :4.0 lumber immas 1 >'J SC
um OA Mp Strta lncr 128
SCOL 100 Cod• uMOVANS15
wMKft
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SOT CHORD
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WV 9 x 4 HF NII.1e:84-0
SURER
Lott 2 It 8 'DF Rb.3 4--5-10
RUCTIM (Ib/llza) gas) 408/0-5-11
08/0-3-11
►ORCES pb) -flat loan Case CfA
TOP Chm ►•z■ -2904, 2-30-21�oe. -4-1630,-•s--�e�3, s -e.-16;
801 CHORD 1-13.3253, '12-•134162, 11-120704, 10-1101704, 0-10.1
:rtes 3-12--624, .4-11.421, 4-100-133, 7-10--387, 6-10.738.
7-8.1323.3-1,5-183
• NOTES ,
1 Provide "uot , drolnoppe to prevent grater ding.
�; This truce hoe been deelgrod Tore 10.0 pef ,bottom 066 lies toad Mone
other leve loads per Teble No, 1629, UBC -07;
3) 4 plate rdtiAQ Muction a( 2Cx has .been appplied for the grain lumber rr
Refer to "am(e) tot truai k- (ruse gvnnectloM.
3) This tress has 1046n desIgme with ANSIPPi 11=1046 c0terlo.
l OV WE'SM it mgora i
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MAA/Tit Vm=Q'fmWWALC4040was J#mN p'1tVeW.•
(�ARIQI A �t-11110; At �1p:19w.1a(N' NAMR�'1p0� NL1'IgO�
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{ TOP CHORD
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SOT CHORD
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10-0-0 at bracing.
WEBS
1 Row at rrtidpt 3-12, 4-10
RUCTIM (Ib/llza) gas) 408/0-5-11
08/0-3-11
►ORCES pb) -flat loan Case CfA
TOP Chm ►•z■ -2904, 2-30-21�oe. -4-1630,-•s--�e�3, s -e.-16;
801 CHORD 1-13.3253, '12-•134162, 11-120704, 10-1101704, 0-10.1
:rtes 3-12--624, .4-11.421, 4-100-133, 7-10--387, 6-10.738.
7-8.1323.3-1,5-183
• NOTES ,
1 Provide "uot , drolnoppe to prevent grater ding.
�; This truce hoe been deelgrod Tore 10.0 pef ,bottom 066 lies toad Mone
other leve loads per Teble No, 1629, UBC -07;
3) 4 plate rdtiAQ Muction a( 2Cx has .been appplied for the grain lumber rr
Refer to "am(e) tot truai k- (ruse gvnnectloM.
3) This tress has 1046n desIgme with ANSIPPi 11=1046 c0terlo.
l OV WE'SM it mgora i
�Smm To arla�am aoKh+s at 0Yp'.SM,lEM1" IN�+ot RA1l1 �1�,1AIOW
MAA/Tit Vm=Q'fmWWALC4040was J#mN p'1tVeW.•
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7Rrmt 414 JISPars / Wt 1
1
FILE No.221 02/21 '03 AM 08:03 ID:YTC/EDAIS ENGR.
02/21i2003 07:13 BIJNSER STEE_ INC a 19283411075
P4067AW M3 1 Roof TRUSS
VUUA 71111MCo. VUMA e.7AZ 36it 4.iot • SRt s tae+ 16 2000
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FAX:520 3411075
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12 'WOM A 391 -
2.2 ftrjjajDj6._
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Im 2 X 4 fiF Stud -G O01 CNORD R9Id OsWQ dlre"y "plied or
11 W t 3 x 6 Or 1ea0r '1.46 4-3-6 1W0-0 to brooMp,
wzu 1 flaw at midpt 4-10
MAClIONS (b/ilio) .8s1406/0-5-8
FORM 00) - " Load Gave Only
MP CHOM 1-2. 2531, 1-11--1531 ;I_4w-2oA 4-3m-1637. 6 -6* -1637, 8-7--1119. 1 -16* -1
OOT CnORO 1-t3-22113. 12-13-220 11-12-11171, 10-11-1671, 9-10-1060, 0-9.0
wmS 3-13-143. 2-120-4W 4.12-400. 4--10.-46. 6-10--440, 6-10-1021, G-9--62
1) Mrafa oem"ke 4rotnv96 to prmrtt ro61r pondlA, R
2 "it trove Roo bw dee ned !ora ICA p boltoOn chard I" load nonraneurMt. lihM any ix I
abler his MM W Tablt N0,
18-9, IJBC-07.
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4 Refer to g1rdsr(s) 1w Ifun to trllts gwmac Ions. ,
b TOiu VM bee 04611 designed with AN31/Tpl 1-1995 cehmla.
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PAGE 4
NO. 19173 GM3
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FILE No.221 02/21 '03 AM 08:03 ID:YTC/EDAIS EPGR.
02/21/2003 07:13 HUNGER STEe. INC 4 19283411WS
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Iti:At 1014 (ft/swoesso/0-87 (IWt 0wl-0), 110317/004 (inpui- 0-3-0)
MON UPW tA■-2200099 ace@ 1), 120-t300(toad wa 3), 0--1370(load can 3)
Moa umv 10■4103(ind batt 3). 12■44wnd 0086 2), 0.2094(wil tsp 3)
PORIZS (ID) - F*W load. rA
Q�p Orluyy
TOP Ch1-2-616. 9-3•-Nj 1-4.414. 4.0&-541., 9-80-JbML 8-74208. 7-80213. a+os-14ft. 1-100-M
IM "NO 15-100-0. 14-106M, 13.14■707, iZ+13+-977, 11-17-174, 10-11■17k 9-10-174
YflD9 s.l 3.1 ■1-14---- 4^1J•-30 -13--lib. f<-13-peD, 8-ti■-1?31s,
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1 Tufa UM Ms VW ObPeWr tat wtl4lof=0 lQ00109 conrpgona.
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7 0 rw 350,0 D0. �Cll
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f TAVDB 817 -Din AVAD / LOT 1
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